构建胸痛救治中心联盟对急性ST段抬高型心肌梗死患者院内诊疗及短期预后的影响研究

Influence of Construction of Association of Chest Pain Treatment in Hospital Diagnosis and Treatment and Short-term Prognosis in Patients with Acute ST-segment Elevation Myocardial Infarction

背景经皮冠状动脉介入治疗(PCI)是急性ST段抬高型心肌梗死(STEMI)患者最为有效的治疗方法,但基层医院受限于基础设施和医疗水平而无法行急诊PCI,进而导致患者病情延误,因此构建胸痛救治中心联盟对提高STEMI的诊疗水平十分重要。目的分析构建胸痛救治中心联盟对急性STEMI患者院内诊疗及短期预后的影响,为综合医院胸痛中心建设积累经验。方法选取2017年9月—2019年1月由医联体医院转诊入徐州市中心医院胸痛中心的急性STEMI患者250例作为观察组,另选取同期由非医联体医院转诊入本院胸痛中心的急性STEMI患者250例作为对照组。比较两组患者胸痛诊疗过程中的关键时间节点(包括基层医院的入院到转出时间、首次医疗接触至确诊时间、到达上级中心医院至球囊扩张时间、首次医疗接触至球囊扩张时间)、PCI后情况(包括院内主要不良心血管事件、院内心源性死亡、住院时间、PCI费用外住院费用)及诊疗满意度。结果观察组患者基层医院的入院到转出时间、首次医疗接触至确诊时间、到达上级中心医院至球囊扩张时间、首次医疗接触至球囊扩张时间短于对照组(P<0.05)。观察组患者院内主要不良心血管事件、院内心源性死亡发生率低于对照组,住院时间短于对照组,PCI费用外住院费用少于对照组(P<0.05)。观察组患者诊疗满意度优于对照组(P<0.05)。结论构建胸痛救治中心联盟可有效缩短急性STEMI患者诊疗时间,降低患者并发症发生率及院内心源性死亡发生率,并有效减轻患者经济负担,提高患者诊疗满意度。

Background Percutaneous coronary intervention(PCI)is one of the most effective treatment methods on acute ST-segment elevation myocardial infarction(STEMI).However,primary hospitals are unable to carry out emergency PCI due to the limited infrastructure and medical level,which lead to the delay of patients'condition.Therefore,it is very important to build the Association of Chest Pain Treatment to improve the diagnosis and treatment level of STEMI.Objective To analyse the influencing of construction of Association of Chest Pain Treatment in hospital diagnosis and treatment and short-term prognosis in patients with acute STEMI,in order to accumulate experience for chest pain center construction in general hospital.Methods From September 2017 to January 2019,a total of 250 patients with acute STEMI transferred from medical association hospital to Chest Pain Center of Xuzhou Central Hospital were selected as observation group,and 250 patients with acute STEMI transferred from non-medical association hospital to Chest Pain Center of Xuzhou Central Hospital were selected as control group.The key time nodes during diagnosis and treatment of chest pain(including time from admission to transfer-out of primary hospital,time from first medical contact to diagnosis,time from arrival at superior central hospital to balloon dilatation,time from first medical contact to balloon expansion),the condition after PCI(including major unconscionable vascular events,cardiogenic death in hospital,length of stay,hospitalization expenses except for PCI expenses)and satisfaction of diagnosis and treatment were compared between two groups.Results The time from admission to transfer-out of primary hospital,time from first medical contact to diagnosis,time from arrival at superior central hospital to balloon dilatation,time from first medical contact to balloon expansion in patients of observation group were shorter than those in patients of control group(P<0.05).The incidence of major unconscionable vascular events in hospital and cardiogenic death in hospital in observation group were lower than those in control group,length of stay in observation group was shorter than that in control group,hospitalization expenses except for PCI expenses in observation group was less than that in control group(P<0.05).Satisfaction of diagnosis and treatment in observation group was better than that in control group(P<0.05).Conclusion Construction of Association of Chest Pain Treatment can effectiely shorten the time of diagnosis and treatment of patients with acute STEMI,redece the incidence of complications and cardiogenic death in hospital,relieve the financial burden,and promote satisfaction of diagnosis and treatment of patients.