辽西地区不同转运途径对急性ST段抬高型心肌梗死救治情况和短期预后的影响

Effect of different transportation mode on the treatment and short-term prognosis of acute ST segment elevation myocardial infarction in Western Liaoning Province

目的 分析不同转运方式对辽西地区急性ST段抬高型心肌梗死（STEMI）患者救治情况及短期预后的影响.方法 纳入辽西地区两家医院共571例STEMI患者,根据患者的转运情况分为自行转运组和救护车转运组.详细记录两组患者的临床资料、症状发作到首次医疗接触时间（STF）、溶栓的比例、急诊PCI的比例、住院总费用、住院期间不良心血管事件、出院后1个月二级预防用药情况及不良心血管事件发生率.结果 救护车转运组189例（33.1％）,自行转运组382例（66.9％）.救护车转运组STF时间显著短于自行转运组[（10.2±4.9）h比（12.3±5.3）h,P＜0.01].救护车转运组溶栓的比例显著高于自行转运组（15.3％比7.9％,P=0.006）.救护车转运组急诊PCI的比例显著高于自行转运组（15.9％比9.9％,P=0.040）.两组患者住院期间不良心血管事件发生率未见统计学差异（13.4％比10.6％,P=0.345）.救护车转运组出院后1个月规律使用二级预防用药比例显著高于自行转运组（60.3％比50.8％,P=0.032）.自行转运组出院后1个月MACE发生率显著高于救护车转运组（13.6％比7.9％,P=0.047）.结论 救护车转运可缩短STEMI患者缺血时间,降低不良心血管事件发生率,改善预后.

Objective To analyze the effect of different medical insnrance in Western Liaoning Province on the treatment and short-term prognosis of patients with acute ST segment elevation myocardial infarction （STEMI）.Methods A total of 571 patients with STEMI were enrolled in two hospitals in Western Liaoning Province.The patients were divided into self-transport group and ambulance-transport group according to the transportation mode in admission.Clinical data,the onset of symptoms to the first medical contact time （Symptom-to-FMC,STF）,intravenous thrombolysis,the proportion of PPCI,major adverse cardiovascular events（MACE） during hospitalization and secondary prevention of medication and the incidence rate of MACE 1 months after discharge were recorded in detail.Results Self-transport group 189 cases （33.1%）,ambulance-transport group 382 case （66.9%）.The STF time of ambulance-transport group was significantly shorter than that of self-transport group [（12.3±5.3）h vs.（10.2±4.9）h,P〈0.01].The proportion of thrombolysis in the ambulance-transport group was significantly higher than that in the self-transport group（15.3% vs.7.9%,P=0.006）.The proportion of emergency PCI in ambulance group was significantly higher than that in self-transport group （15.9% vs.9.9%,P=0.040）.There was no significant difference in adverse cardiovascular events between the two groups during the period of hospitalization （13.4% vs.10.6%,P=0.345）.The proportion of regular secondary prevention of medication 1 months after discharge significant higher in the ambulance-transport group（60.3% vs.50.8%,P=0.032）.The incidence of MACE was significantly higher in ambulance-transport group than that of ambulance-transport group 1 months after discharge （13.6% vs.7.9%,P=0.047）.Conclusion Emergency vehicle transport can reduce the ischemic time of STEMI patients,reduce the adverse cardiovascular events,and improve the prognosis.