基层医院转运患者与转运医师行急诊经皮冠状动脉介入治疗对ST段抬高型心肌梗死患者预后的影响

Effect of emergency percutaneous coronary intervention on prognosis of patients with ST-segment elevation myocardial infarction by transferring patients versus physicians in county hospitals

目的比较基层医院转运患者与转运医师行急诊经皮冠状动脉介入治疗(PCI)对ST段抬高型心肌梗死(STEMI)患者预后的影响.方法将219例首诊在基层医院接受急诊PCI的STEMI患者随机分为转运患者组112例和转运医师组107例,比较两组患者的一般资料、从进入初诊医院大门到再灌注的时间(D-B)、首次医疗接触到PCI球囊扩张的时间(FMC-B)、冠状动脉病变特征及预后.结果转诊医师组全球急性冠状动脉事件注册研究(GRACE)积分低危、术后心肌梗死溶栓试验(TIMI)心肌灌注分级(TMPG)为2级患者比例、D-B及FMC-B均低于转诊患者组,GRACE积分中危、术后TIMI血流分级为3级、术后TMPG为3级患者比例均高于转诊患者组(P<0.05).转运医师组再梗死、梗死后心绞痛、心功能killip分级Ⅲ级以上及严重心律失常患者比例均低于转运患者组,左心室射血分数高于转运患者组(P<0.05).结论基层医院转运医师较转运患者行急诊PCI可缩短救治时间,减少STEMI的并发症.

Objective To compart*the effect of emergency percutaneous coronary intervention(PCI)on prognosis of patients with ST segment elevation myocardial infarction(STEMI)by transferring patients versus physicians in county hospitals.Methods A total of 219 patients with STEMI who received emergency PCI and were first diagnosed in primary hospitals were randomly divided into transfer patients group(112 cases)and transfer physicians group(107 cases).General data,time from entering the primary hospital gate to reperfusion(D-B),time from the first medical contact to PCI balloon dilatation(FMC-B),characteristic of coronary artery lesions and prognosis were compared between the two groups.Results Ratios of patients whose global registration of acute coronary events(GRACE)score were low-risk and postoperative blood flow classification of myocardial infarction thrombolysis test(TIMI)myocardial perfusion classification(TMPG)were grade 2,D-B and FMC-B in transfer physicians group were lower than those in transfer patients group,while ratios of patients whose GRACE score were medium-risk,postoperative blood flow classification of TIMI were grade 3 and postoperative TMPG were grade 3 were higher than those in transfer patients group(P<0.05).Ratios of patients with reinfarction,post-infarction angina,cardiac function killip grade Ⅲ or above and severe arrhythmia in transfer physicians group were lower than those in transfer patients group,while left ventricular ejection fraction was higher than that in transfer patients group(P<0.05).Conclusion Emergency PCI by transferring physicians can shorten the treatment time and reduce complications of STEMI compared with transferring patients in county hospitals.