胸痛中心模式下不同来院途径急性STEMI病人行PCI治疗再灌注时间的比较

Comparison of reperfusion time of acute STEMI patients by different approaches to hospital treated with PCI under chest pain center mode

目的:比较胸痛中心模式下不同来院途径急性ST段抬高型心肌梗死(STEMI)病人行直接经皮冠状动脉介入治疗(PCI)再灌注时间,探讨改进现有胸痛中心的措施。方法:选取行直接PCI的STEMI病人194例,根据来院途径不同分为自行来院组60例、120呼救组85例和非PCI医院转诊组49例。观察3组病人发病-球囊时间、发病至首次医疗接触时间、首次医疗接触-球囊扩张(FMC2B)时间、FMC2B时间达标率、大门-球囊扩张(D2B)时间、D2B时间达标率、首次医疗接触-心电图时间等指标。结果:3组病人D2B时间均低于90 min标准,120呼救组明显短于自行来院组(P<0.01)。非PCI医院转诊组发病-球囊时间、首次医疗接触-心电图时间、FMC2B时间均明显长于自行来院和120呼救组(P<0.01),FMC2B时间达标率明显低于自行来院和120呼救组(P<0.01)。结论:现行胸痛中心模式下院前延误,尤其基层非PCI医院诊疗、转运延误明显,需要进一步改进。

Objective:To compare the reperfusion time of patients with acute ST-segment elevation myocardial infarction(STEMI)by different approaches to hospital treated with primary percutaneous coronary intervention(PCI),and to explore the measures to optimize the existing chest pain center.Methods:A total of 194 STEMI patients undergoing primary PCI were selected and divided into self-admission group(60 cases),120 call for help group(85 cases)and non-PCI hospital referral group(49 cases).The onset-to-balloon time,symptom-to-first medical contact time,first medical contact-to-balloon(FMC2B)time,qualified rate of FMC2B time,door-to-balloon(D2B)time,qualified rate of D2B time,first medical contact-to-ECG time and so on were observed in there groups.Results:The D2B time in the three groups was below the 90-minute standard,which in 120 call for help group was obviously shorter than that in self-admission group(P<0.01).The onset-to-balloon time,first medical contact-to-ECG time,FMC2B time in non-PCI hospital referral group were significantly longer than those in self-admission group and 120 call for help group(P<0.01),and the qualified rate of FMC2B time was significantly lower than that in self-admission group and 120 call for help group(P<0.01).Conclusions:Pre-hospital delays under the current chest pain center mode,especially non-PCI treatment in primary hospitals,are obvious and need further improvement.