江阴市急性心肌梗死患者的救治进展及优化策略

Treatment progress and optimization strategies of acute myocardial infarction patients in Jiangyin city during 3 years

目的 调查分析江阴市3年来急性心肌梗死（AMI）患者的就诊情况、再灌注现状、生存状况及改善患者预后的方法.方法 对近3年来在江阴市44家医院、卫生院就诊的AMI患者的诊治情况、转诊状况、再灌注策略、就诊-溶栓或就诊-球囊扩张时间、住院期间及AMI后6个月内生存状况等进行调查,比较2013年、2014年、2015年江阴市开展优化＂急性心肌梗死急救流程＂后AMI患者总体救治现状的改善,探讨进一步改进的措施.结果 2013-2015年江阴市AMI患者再灌注治疗率分别为75.4%、83.8%、87.4%;就诊-球囊扩张时间分别为（248.4±121.6）min、（205.8±112.9）min、（150.5±50.9）min,就诊-球囊扩张时间逐年缩短（P〈0.05）;门-球时间分别为（129.5±33.3）min、（103.6±25.5）min、（90.2±20.1）min,门-球时间逐年缩短（P〈0.05）;年住院期间总心血管事件分别为37例、30例、22例,6个月内心血管事件分别为49例、42例、32例,2015年住院期间及AMI后6个月心血管事件较2013年低（P〈0.05）.结论 利用现代通讯技术建立覆盖县域内AMI的救治体系及优化AMI患者的急救流程,能够早期快速诊断AMI,缩短转诊时间、就诊-球囊扩张的时间及门-球时间,改善AMI患者的预后.

Objective To investigate and analyze the situation and reperfusion status and living conditions and methods to improve the prognosis of patients with acute myocardial infarction （AMI） in our city. Methods The time of visit-balloon time and door-to-balloon time and reperfusion strategy were investigated in 44 hospitals and health centers. The cardiovascular events and survival condition were compared during hospitalization and 6 months after AMI during 3 years. The measures for further improvement of the overall treatment status and were ex-plored after the acute myocardial infarction emergency treatment process. Results The rate of reperfusion therapy in patients with AMI in our city were 75.4% and 83.8% and 87.4% from 2013 to 2015. The time of visit-balloon time and door-to-balloon time were shortened year by year from 2013 to 2015（P〈0.05）. The cardiovascular events were 37 cases in 2013 and the events were 30 cases in 2014 and the events were 22 cases in 2015 during hospi-talization. The cardiovascular events were 49 cases in 2013 and the events were 42 cases in 2014 and the events were 32 cases 6 months after AMI. The cardiovascular events were less in 2015 than 2013 during hospitalization and 6 months after AMI（P〈0.05）. Conclusion Using modern communication technology to establish emergency aid of A-MI within the county and optimizing the first aid flow of AMI can improve early diagnoses and reperfusion therapy for AMI. These can shorten visit-balloon time and door-to-balloon time and improve the prognosis of patients with AMI.