延迟转入冠心病监护室对非ST段抬高急性冠状动脉综合征患者预后的影响

The effect of delayed CCU transfer on the prognosis of non-ST-segment elevation acute coronary syndrome

目的分析非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者延迟转入冠心病监护室(CCU)治疗对患者预后的影响。方法回顾性分析因NSTE-ACS于急诊就诊的患者共664例。根据从急诊就诊到转入CCU监护的时间分为>12 h(延迟组)和≤12 h组(对照组)。记录所有患者到达急诊就诊到转入CCU监护的时间,记录所有患者的基本疾病特征、入院检查的血脂四项水平,以及两组患者是否采用PCI治疗的比例;所有患者入院时在急诊科均采用GRACE风险评分对患者的风险程度进行评估;结局观察指标包括患者行PCI治疗的比例,患者住院时间,住院期间病死率,住院期间的出血事件发生率、卒中发生率,记录两组患者治疗前和出院时左心射血分数(LVEF)。结果两组患者接诊时心功能Killip分级患者比例和GRACE风险评分分级的患者比例对比差异无统计学意义(P>0.05),其中延迟组患者住院期间行PCI的比例与对照组比较差异无统计学意义(x^2=1.178,P=0.278),两组住院期间的病死率、卒中比例对比差异均无统计学意义(P>0.05),但延迟组患者的住院时间和出血事件的发生率均显著高于对照组,差异有统计学意义(P<0.05),两组患者中包括行PCI和非PCI治疗的患者,两组治疗前和治疗后的LVEF对比差异均无统计学意义(P>0.05)。结论 NSTE-ACS患者延迟转入CCU治疗(>12 h)增加了其出血事件的相关风险,并延长了患者的住院时间。

Objective To analyze the effect of delayed transfer of CCU on the prognosis of non-ST-segment elevation acute coronary syndrome（ NSTE-ACS）. Methods A total of 664 patients with NSTE-ACS were retrospectively analyzed. According to time from emergency visits to CCU guardianship,the patients were divided into 12 h group（ delayed group） and ≤12 h group（ control group）. The basic disease characteristics,blood lipid levels at admission and PCI therapy rate were recorded. GRACE risk score was used to assess risk level among patients at emergency department at admission. The hospital stay,mortality during hospitalization,bleeding events and stroke were recorded during hospitalization; and left ventricular ejection fraction（ LVEF） before and after treatment in two groups were also recorded. Results There was no significant difference in heart function Killip classification or GRACE risk score at admission between the two groups（ P〈0. 05）. In delayed group,the PCI rate during hospitalization was significantly different from that in control group（ x^2= 1. 178,P = 0. 278）. There was no significant difference in the mortality rate or stroke ratio between the two groups during hospitalization（ P〈0. 05）. However,the hospital stay or the incidence of bleeding events in delayed group were significantly higher than those in control group（ P〈0. 05）. There was no significant difference in LVEF between the two groups before or after treatment（ P〈0. 05）. Conclusion Delayed engraftment of CCU（ 12 h） increases the risk of bleeding and prolongs hospital stay in patients with NSTE-ACS.