院外急救与院内救治无缝衔接模式下的急性ST段抬高型心肌梗死行急诊介入治疗患者的预后价值

Prognostic value of emergency interventional therapy in patients with acute ST segment elevation myocardial infarction under seamless connection of pre-hospital first aid and in-hospital treatment

目的评估院外急救与院内救治无缝衔接模式下的急性ST段抬高型心肌梗死(STEMI)介入治疗患者的预后价值。方法将2017年11月-2018年10月收住苏州大学附属第三医院常州市第一人民医院急诊科的162例STEMI介入治疗患者,依据是否经本地急救中心救护系统转运分为研究组(经急救中心救护系统转运)45例和对照组(自行或者其它医疗机构转院来院)117例。记录两组患者门-球(D to B)时间,住院期间心衰、心律失常发生率,以及死亡率和出院后半年再次心肌梗死发生率。结果研究组DtoB时间显著短于对照组(P=0.001),且研究组90 min内完成球囊扩张比例显著高于对照组(P=0.001);研究组在住院期间心力衰竭(P=0.013)和心律失常(P=0.009)发生率均显著低于对照组,住院期间死亡率(P=0.536)和6个月再次心肌梗死率(P=0.535)无明显差异。结论院外急救与院内救治无缝衔接模式可缩短STEMI患者再灌注时间,降低住院期间心脏事件发生率并改善近期预后。

Objective To evaluate the prognostic value of interventional therapy for acute ST segment elevation myocardial infarction(STEMI)under the seamless mode of pre-hospital first aid and in-hospital treatment.Methods From November 2017 to October 2018,162 patients with STEMI intervent ional therapy were admitted to the emergency department of Changzhou First People's Hospital,the Third Afiliated Hospital of Suzhou University.According to whether they were transferred by the rescue system of the local emergency center,they were divided into study group(transferred by the rescue system of the emergency center)45 cases and control group(ransferred by themselves or other medical institutions)117 cases.The door to ball(D to B)time,the incidence of heart failure,arrhyhmia and mortality during hospitalization,and the incidence of myocardial infarction in half a year after discharge were recorded.Results The time of D to B in the study group was signifcantly shorter than that in the control group(P=0.001),and the proportion of balloon dilatation completed in 90 minutes in the study group was significantly higher than that in the control group(P=0.001);the ineidence of heart failure(P=0.013)and arhythmia(P=0.009)in the study group was signifcantly lower than that in the control group,and there was no significant difference in mortality(P=0.536)and myocardial infarction rate in June(P=0.535).Conclusion The seamless connection mode of pre-hospital emergency and in hospital treatment can shorten the reperfusion time of STEMI patients,reduce the incidence of heart events during hospitalization and improve the short-term prognosis.