在优化改进后的绿色通道下直接经皮冠状动脉介入治疗对ST段抬高型急性心肌梗死患者门-球扩张时间及预后的影响

Effect of direct percutaneous coronary intervention under improved green channel on balloon dilatation time and clinical prognosis in patients with ST-segment elevation myocardial infarction

目的 观察优化改进后的绿色通道下直接经皮冠状动脉(冠脉)介入治疗(PCI)对ST段抬高型心肌梗死(STEMI)患者球囊扩张所需时间及预后的影响.方法 选择云南省急救中心2016年6月至2019年12月出诊救治的177例STEMI患者作为研究对象.以2016年6月至2017年5月救治的52例STEMI患者为传统模式组〔按照传统绿色通道抢救模式将患者送入冠心病重症监护病房(CCU)进行救治〕;以2017年6月至2019年12月收治的125例STEMI患者为优化模式组(按照优化后的绿色通道抢救模式将患者送至介入室进行救治).比较两组患者球囊扩张所需时间和预后.结果 优化模式组入门至描记心电图时间(min:7.23±1.87比11.07±2.98)、描记心电图至签字时间(min:8.38±1.86比10.65±2.24)、签字至进入导管室时间(min:8.64±2.33比12.33±2.76)、进入导管室至进入穿刺鞘时间(min:9.95±2.31比13.62±3.37)、入门至球囊扩张时间(min:39.03±9.89比62.68±11.65)均较传统模式组明显缩短(均P<0.05).两组出院时全球急性冠脉事件注册评分(GRACE)均较入院时降低,且出院时优化模式组GRACE明显低于传统模式组(分:70.92±11.99比92.93±15.22,P<0.05).优化模式组住院治疗费用较传统模式组明显减少(万元:3.06±0.34比4.94±0.38,P<0.05),住院时间较传统模式组明显缩短(d:10.35±2.16比14.80±2.23,P<0.05).优化模式组患者严重心律失常发生率〔5.60%(7/125)比7.69%(4/52)〕、继发心力衰竭发生率〔1.60%(2/125)比3.85%(2/52)〕、因心源性疾病再次入院率〔1.60%(2/125)比11.54%(6/52)〕、全因病死率〔0.80%(1/125)比9.62%(5/52)〕、心源性病死率〔1.60%(2/125)比11.54%(6/52)〕均低于传统模式组.结论 与传统绿色通道救治模式相比,在优化改进后的绿色通道模式下救治STEMI患者球囊扩张时间更短,可提高PCI疗效,患者预后良好.

Objective To observe the effect of direct percutaneous coronary intervention(PCI)under the improved green channel on the balloon dilation time and prognosis of patients with ST-segment elevation myocardial infarction(STEMI).Methods The 177 STEMI patients who were treated in Emergency Center of Yunnan Province from June 2016 to December 2019 were selected as research objects,and 52 STEMI patients treated from June 2016 to May 2017 were as traditional mode group[the patients were sent to the coronary heart disease intensive care unit(CCU)through the traditional green channel];the 125 STEMI patients treated from June 2017 to December 2019 were as the optimized mode group(the patients were sent to the intervention room through the improved green channel).The balloon dilation time and prognosis of the two groups were compared.Results In optimized mode group,the time from entry to tracing electrocardiogram(minutes:7.23±1.87 vs.11.07±2.98),time from tracing electrocardiogram to signature(minutes:8.38±1.86 vs.10.65±2.24),time from signing to entering catheter room(minutes:8.64±2.33 vs.12.33±2.76),time from entering catheter room to puncture sheath(minutes:9.95±2.31 vs.13.62±3.37),and time from entry to balloon dilation(minutes:39.03±9.89 vs.62.68±11.65)were all significantly shorter than those in the traditional mode group(all P<0.05).The global acute coronary event registration score(GRACE)of the two groups at discharge was lower than that at admission,and the GRACE of the optimized mode group at discharge was significantly lower than that of the traditional mode group(points:70.92±11.99 vs.92.93±15.22,P>0.05).The cost of hospitalization in optimized mode group was significantly lower than that in the traditional mode group(ten thousand Yuan:3.06±0.34 vs.4.49±0.38,P<0.05),and the hospital stay was significantly shorter than that in the traditional mode group(days:10.35±2.16 vs.14.80±2.23,P<0.05).In the optimized mode group,the incidence of severe arrhythmia[5.60%(7/125)vs.7.69%(4/52)],incidence of secondary heart failure[1.60%(2/125)vs.3.85%(2/52)],re-hospitalization rate of cardiogenic disease[1.60%(2/125)vs.11.54%(6/52)],all-cause mortality rate[0.80%(1/125)vs.9.62%(5/52)],and cardiogenic fatality rate[1.60%(2/125)vs.11.54%(6/52)]were all lower than those of the traditional mode group.Conclusion Compared with the traditional green channel treatment,under the improved green channel model,the treatment of STEMI patients has shorter balloon dilation time and can improve the efficacy of PCI,as a result,the patients have good prognosis.