272例急性ST段抬高型心肌梗死患者现状及治疗

Retrospective Analysis of Current Status and Therapy of 272 Patients with ST Segment Elevation Acute Myocardial Infarction

目的:分析272例急性ST段抬高型心肌梗死(STEMI)患者的治疗现状。方法:收集住院治疗的272例STEMI患者的资料,根据患者的来源分为贵阳地区组128例,其他地区组144例(包括除贵阳市以外的贵州省其他市县和除贵州省以外的其他省市),并收集两组患者的一般资料及临床特征,评估两组患者在住院期间的血运重建治疗及药物使用情况。结果:贵阳地区组发病>12 h入院的患者50例(39.1%),明显低于其他地区组患者的102例(70.8%),P<0.05;在治疗方面,贵阳地区STEMI患者急诊血运重建率显著高于其他地区患者(P<0.05);此外,贵阳地区STEMI患者行急诊经皮冠状动脉介入治疗(PCI)的比例也明显高于其他地区组(P<0.05);未行急诊血运重建原因分析显示,患者超时间窗就诊在贵阳地区和其他地区组中的构成比分别为75.4%和89.2%;未行择期PCI的原因分析显示,贵阳地区和其他地区分别有46.9%和44.4%患者拒绝择期PCI。两组患者的医保类型有显著差异,但治疗总费用差异无统计学意义;两组患者在药物使用方面差异均无统计学意义,其中阿司匹林、氯吡格雷、低分子肝素、他汀类药物的使用均超过了98%。结论:贵阳地区STEMI患者延误就诊的比例较其他地区组低。延误就诊是导致急诊血运重建比例低的主要原因。

Objective： To analyze the current therapeutic status of patients with ST segment elevation myocardial infarction（ STEMI）. Methods： 272 patients with STEMI were collected in our hospital from January 2016 to October 2016 including 128 cases from Guiyang region and 144 cases from the other regions in Guizhou,China. The current therapeutic status and the difference between the groups were retrospectively analyzed. Results： The proportion of the patients whose onset before admission to hospital lasted for more than 12 h in other regions was significantly higher than that in Guiyang region（ 70. 8% Vs 39. 1%,P = 0. 00）. Only 52. 3% of patients in Guiyang region received emergency revascularization compared with 29. 2% of patients in other regions（ P = 0. 00）. This difference was mainly resulted from the lower rate of percutaneous coronary intervention（ PCI） in patients from other region compared with patients from Guiyang region（ 42. 2% Vs 20. 1%,P = 0. 00）. Among the patients without emergency revascularization,75. 4% cases from Guiyang region and 89. 2% cases from other region selected therapeutic time-window. Of these patients,46. 9% from Guiyang region and44. 4% from other region refused the delayed PCI. No difference was observed in the medication treatment. Conclusion： The rate of treatment-seeking delay of patients with STEMI from Guiyang region was lower than that from other regions,but the delay was still severe. treatment-seeking delay was themain cause for the low rate of primary PCI. Selective PCI was not well performed mainly by the rejection from patients.