新型冠状病毒肺炎疫情期间胸痛中心应急化管理对急性ST段抬高型心肌梗死救治的影响

Eff ects of emergency management of chest pain center on the treatment of acute ST-segment elevation myocardial infarction during the outbreak of novel coronavirus pneunonia

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间胸痛中心应急化管理对急性ST段抬高型心肌梗死(STEMI)救治的影响。方法通过回顾性研究方法,选取绵阳市中心医院胸痛中心COVID-19疫情期间实施应急管理前(2020年1月23日至2月24日)收治的39例行急诊经皮冠状动脉介入治疗(PCI)的STEMI患者、应急管理后(2020年2月25日至3月27日)收治的43例患者、应急管理前相应的去年同期(2019年1月23日至2月24日)收治的42例患者为研究对象,分为应急管理前组、应急管理后组、去年同期组。比较三组患者首次医疗接触到首份心电图完成时间、进入医院大门至球囊扩张(D-to-B)时间、导管室激活时间、首次医疗接触到负荷剂量双联抗血小板给药时间、经救护车入院且接受急诊PCI绕行急诊和冠心病监护病房(CCU)直达导管室的比例和院内主要不良心脑血管事件(MACCE)发生情况。结果(1)与应急管理前组比较,应急管理后组和去年同期组的首次医疗接触到首份心电图完成时间[(7.36±2.46)min比(15.84±3.57)min,(6.96±3.02)min比(15.84±3.57)min]、D-to-B时间[(68.57±12.95)min比(91.36±12.42)min,(66.36±15.56)min比(91.36±12.42)min]、导管室激活时间[(15.96±5.53)min比(23.24±4.75)min,(16.13±4.67)min比(23.24±4.75)min]、首次医疗接触到负荷量双联抗血小板给药时间[(13.15±7.34)min比(26.85±9.35)min,(12.43±9.03)min比(26.85±9.35)min]均缩短,而经救护车入院且接受急诊PCI治疗绕行急诊和CCU直达导管室的比例均升高(60.47%比2.56%,66.67%比2.56%),差异均有统计学意义(均P<0.05);而应急管理后组与去年同期组各项指标比较,差异均无统计学意义(均P>0.05)。(2)三组患者的死亡、心室颤动、再发心肌梗死、脑血管事件的发生率比较,差异均无统计学意义(均P>0.05)。与应急管理前组比较,应急管理后组和去年同期组的术后24 h内左心室射血分数≤40%的比例(9.30%比15.38%,7.14%比15.38%)、MACCE发生率(11.63%比25.64%,11.90%比25.64%)均降低,差异均有统计学意义(均P<0.05);而应急管理后组与去年同期组这些指标比较,差异均无统计学意义(均P>0.05)。结论在COVID-19疫情期间,胸痛中心应急化管理可以有效缩短STEMI患者的救治时间,改善患者预后,值得临床推广。

Objective To explore the eff ect of emergency management of chest pain center on the treatment of acute ST-segment elevation myocardial infarction(STEMI)during the outbreak of corona virus disease 2019(COVID-19).Methods By the method of retrospective study,39 cases of STEMI patients taken emergency percutaneous coronary intervention(PCI)admitted to Chest Pain Center of Mianyang Central Hospital during the outbreak of COVID-19 before the implementation of emergency management(from January 23 to February 24,2020),43 patients after the implementation of emergency management(from February 25 to March 27,2020),and 42 patients in the same period last year(from January 23 to February 24,2019)before the implementation of emergency management were selected as research objects,they were taken as pre-emergency management group,the post-emergency management group and the last year corresponding group respectively.The time from fi rst medical contact to complete of fi rst electrocardiogram,door to balloon(D-to-B)time,activation time of cath lab,time from fi rst medical contact to loading dose of dual antiplatelet administration,the proportion of ambulance admission and directly to cath lab instead of emergency room or CCU,and the incidence of main adverse cardiovascular and cerebrovascular events(MACCE)were compared among three groups.Results(1)Compared with the pre-emergency management group,the time from first medical contact to complete of first electrocardiogram[(7.36±2.46)min vs.(15.84±3.57)min,(6.96±3.02)min vs.(15.84±3.57)min],and the D-to-B time[(68.57±12.95)min vs.(91.36±12.42)min,(66.36±15.56)min vs.(91.36±12.42)min],activation time of cath lab[(15.96±5.53)min vs.(23.24±4.75)min,(16.13±4.67)min vs.(23.24±4.75)min],time from first medical contact to loading dose of dual antiplatelet administration[(13.15±7.34)min vs.(26.85±9.35)min,(12.43±9.03)min vs.(26.85±9.35)min]in the post-emergency management group and the last year corresponding group were all shortened,the proportion of ambulance admission and directly to cath lab instead of emergency room or CCU was increased(2.56%vs.66.67%,2.56%vs.60.47%),and the diff erences were all statistically significant(all P<0.05).There were no statistically significant differences of these indicators between the post-emergency management group and last year corresponding group(all P>0.05).(2)There were no statistically signifi cant diff erences in the incidence of death,ventricular fi brillation,recurrent myocardial infarction and cerebrovascular events among the three groups(all P>0.05).Compared with the pre-emergency management group,the proportion of left ventricular ejection fraction≤40%within 24 h after surgery(9.30%vs.15.38%,7.14%vs.15.38%)and the incidence of MACCE(11.63%vs.25.64%,11.90%vs.25.64%)in the postemergency management group and last year corresponding group were all reduced,with statistically signifi cant diff erences(all P<0.05).There were no statistically signifi cant diff erences of these indicators between the postemergency management group and last year corresponding group(all P>0.05).Conclusions During the outbreak of COVID-19,emergency management of chest pain center can eff ectively shorten the treatment time of STEMI patients and improve the prognosis of patients,which is worthy of clinical promotion。