心血管专科急诊的成立对急性ST段抬高型心肌梗死患者救治的影响

Effects of full day on-site cardiologists in emergency room on outcomes in patients with acute ST-elevated myocardial infarction

目的:探讨心血管专科急诊的成立对于急性ST段抬高型心肌梗死(STEMI)患者救治的影响。方法:收集沈阳军区总医院2016年1~10月收治的STEMI患者为观察组,未成立专科急诊之前2014年1~10月收治的STEMI患者为对照组,共入选患者1126例,其中观察组636例,对照组490例。观察组入急诊后由心血管专科急诊医师接诊,对照组在专科急诊成立之前入院后由急诊科医师接诊,进行常规救治。观察两组STEMI患者的一般情况、急诊收治时间、入门-球囊扩张时间(DTB)、经皮冠状动脉介入治疗(PCI)支架置入情况、随访30 d及1年不良事件。结果:与专科急诊成立之前相比,急诊收治时间、入门-球囊扩张时间明显缩短,差异有统计学意义(P<0.05);观察组急诊置入支架的比率明显增加,差异有统计学意义(P<0.05);30 d随访不良事件(包括心源性死亡、心肌梗死、靶血管重建、支架内血栓、脑卒中)两组差异无统计学意义(P>0.05),随访1年,观察组不良事件明显低于对照组,两组差异有统计学意义(P<0.05)。结论:专科急诊的成立有效缩短了急性ST段抬高型心肌梗死患者的救治时间,提高治疗效率,降低远期不良事件,值得临床中进一步推广。

Objective：To assess the effects of full day on-site cardiologists in emergency room on outcomes in patients with acute ST-elevated myocardial infarction（STEMI）. Methods：A total of patients with 636 STEMI patients who were admitted after the establishment of the specialized emergency medical services（Jan-Oct,2016）,were regarded as the observation group,and 490 STEMI patients admitted before the establishment of specialized emergency medical services（Jan-Oct, 2014）were regarded as control group. The baseline characteristics,the stay in emergency room,the door to balloon time（DTB）, the rate of stent implantation in percutaneous coronary intervention（PCI）,and adverse events in 30 days and 1 year follow-up were compared between the two groups. Results：There were no significant differences in the baseline characteristics between the two groups（P〈0.05）. The stay in emergency room and the door to balloon time（DTB） were shorter in observation group than that in control group,with statistically significant difference（P〈0.05）. The rate of stent implantation in PCI was higher in observation group than that in control group,with statistically significant difference（P〈0.05）. There were no significant differences in 30 days adverse events between the two groups（P〉0.05）,but adverse events,there were statistically significant differences（P〈0.05） at 1 year. Conclusion： Optimized specialized emergency treatment may effectively shorten the rescue time for patients with STEMI, improve the efficiency of treatment and long-term outcomes,and is worthy of further dissemination.