互联网+急性心肌梗死规范化快速救治体系对急性ST段抬高型心肌梗死患者救治预后的影响

Influence of internet+standardized rapid treatment system for acute myocardial infarction on prognosis in patients with acute ST-segment elevation myocardial infarction

目的探讨互联网+急性心肌梗死规范化快速救治体系(ISRTS)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)急救预后的影响。方法采用回顾性非同期队列研究方法。郑州市第一人民医院自2017年11月开始实施ISRTS及流程,选取未实施ISRTS之前的2017年4月至2017年10月收治可行PCI的STEMI患者为对照组(106例),采用传统模式进行常规救治;选取2017年11月至2018年5月收治可行PCI的STEMI患者为观察组(110例),采取ISRTS及流程进行救治。比较两组患者的一般资料、快速反应指标、入院时病情程度指标、住院期间并发症、社会效益指标、术后6个月主要不良心脏事件等。结果观察组的快速反应指标(发病至呼救120时间、发病至首次心电图完成时间、发病至入院时间、入院至首次心肌酶完成时间、入门-球囊扩张时间、首次医疗接触到血管开通时间)均短于对照组(P均<0.001),入院时病情程度指标(cTnI、NT-proBNP、LVEF、LVESD、LVEDD、hs-CRP)均轻于对照组(P均<0.01),主动脉球囊反搏应用率低于对照组(P<0.05),社会效益指标(药占比、平均住院费用、平均住院时间、患者满意度)均优于对照组(P均<0.001),住院期间并发症(心功能不全、心源性休克、室壁瘤、恶性心律失常及总并发症)发生率低于对照组(P均<0.05),术后6个月主要不良心脏事件低于对照组(P<0.001)。结论ISRTS建立优化STEMI救治流程,提高救治效率,缩短心肌再灌注时间,减少并发症,有效改善STEMI患者的临床预后,创造了良好的社会效益。

Objective To investigate the influence of internet+standardized rapid treatment system(ISRTS)for acute myocardial infarction(AMI)on the prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)undergone PCI.Methods Retrospective non-synchronous cohort study was used in this study.ISRTS and its procedure were carried out in the First People’s Hospital of Zhengzhou City on Nov.2017.STEMI patients with planed PCI(n=106)were chosen into control group before ISRTS from Apr.2017 to Oct.2017,and the control group was given traditional treatment.STEMI patients with planed PCI(n=110)were chosen into observation group from Nov.2017 to May 2018,and the observation group was given ISRTS and its procedure.The general data,rapid response indexes,indexes of disease severity at admission time,complications during hospitalization,social efficacy indexes and major adverse cardiovascular events(MACE)6 months after the procedure were compared between 2 groups.Results The rapid response indexes(the time from disease onset to call ambulance,time from disease onset to finish of the first electrocardiogram(ECG)and admission,finishing time of the first myocardial enzymes detection,door-to-balloon dilation time,time from the first medical contact to open blood vessels)were all shorter in observation group than those in control group(all P<0.001).The indexes of disease severity at admission time(cTnI,NT-proBNP,LVEF,LVESd,LVEDd,hs-CRP)were all milder,and application rate of intra-aortic balloon pumps(IABP)was lower in observation group than those in control group(P<0.05).The social efficacy indexes(drug proportion,average hospitalization cost,average hospitalization time and patient satisfaction)were all superior in observation group to those in control group(all P<0.001).The incidence rates of complications during hospitalization(cardiac insufficiency,cardiogenic shock,ventricular aneurysm,malignant arrhythmia and total complications)were lower observation group than those in control group(all P<0.05).The incidence rate of MACE was lower in observation group than that in control group(P<0.001).Conclusion ISRTS establishes and optimizes STEMI treatment process,improves treatment efficiency,shortens myocardial reperfusion time,reduces complications,effectively improves the clinical prognosis in STEMI patients,and creates good social benefits.