区域化协同救治在急性冠脉综合征患者中的应用

Application of regional collaborative treatment in patients with acute coronary syndrome

目的探讨临床路径在区域化协同救治急性冠脉综合征患者中的应用效果。方法选择2017年1月至2018年1月我院救治的急性冠脉综合征患者148例,根据是否采用"区域化协同救治"分为区域化协同救治组75例和非区域化协同救治组53例,非区域化协同救治组采用常规急诊救治流程,区域化协同救治组结合临床路径实施区域化协同救治。比较两组患者术后心功能、救治时间及并发症发生率。结果区域协同救治组患者平均首次医疗接触至球囊扩张时间(D-to-B时间)、平均溶栓时间明显较非区域化协同救治组缩短(P <0. 05)。区域化协同救治组术后1 d、术后1个月、术后3个月LEVF、LVED心功能指标均优于非区域化协同救治组(P <0. 05),且术后3个月心脏功能分级也优于非区域化协同救治组(P <0. 05)。术后3个月,区域化协同救治组发生心绞痛6例,心律失常2例,无再发心肌梗死、心源性死亡,对照组发生心绞痛11例,心律失常6例,再发心肌梗死2例、心源性死亡1例,两组并发症比较差异有统计学意义(P <0. 05)。结论将临床路径区域化协同救助模式整合到院前急救、医院间转诊过程可有效缩短冠脉综合征患者全程救治时间,最大程度将其救护时间控制在120 min以内。

Objective To explore the clinical application effect of clinical pathways in the treatment of patients with acute coronary syndrome.Methods A total of148patients with acute coronary syndrome who were treated in our hospital from January2017to January2018were selected.According to whether they were treated with“regional coordinated treatment”or not,a total of75patients were divided into regional collaborative treatment group and a total of53cases were selected as the non-regional collaborative treatment group.The non-regional collaborative treatment group was treated with routine emergency treatment process,while the regional collaborative treatment group was treated by regional collaborative treatment combined with clinical pathways.The postoperative cardiac function,treatment time and complication rate were compared between the two groups.Results The average time from first medical contact to balloon dilation(D-to-B time)and average thrombolysis time in the regional collaborative treatment group were significantly shorter than that in the non-regional collaborative treatment group(P<0.05).The LEVF and LVED cardiac function indexes of the regional collaborative treatment group were better than that of the non-regional collaborative treatment group after1day of operation,1month of operation,and3months of operation(P<0.05).In addition,the cardiac function grade was better than that of the non-regional collaborative treatment group after3months of operation(P<0.05).Three months after the operation,there were6patients had angina pectoris in the regional collaborative treatment group,2patients had arrhythmia and no patients had recurrent myocardial infarction and cardiac death.In the control group,a total of11patients had angina pectoris.A total of6patients had arrhythmia.A total of2patients had recurrent myocardial infarction and there was a case of cardiac death.The difference in complications between the two groups was statistically significant(P<0.05).Conclusion Integrating the clinical pathway regional collaborative rescue model into pre-hospital first aid and inter-hospital referral process can shorten the treatment time of patients with coronary syndrome effectively and control the rescue time within120min.