绕行急诊科对急性前壁心肌梗死患者急诊介入治疗效果的影响

Influence of bypassing department of emergency on therapeutic effect of emergency intervention in AAMI patients

目的:探讨绕行急诊科对急性前壁心肌梗死患者急诊介入治疗效果的影响。方法:在我院心内科行直接经皮冠状动脉介入治疗(PPCI)的急性前壁心肌梗死患者102例,按照是否绕行急诊科分成绕行组(47例)和无绕行组(55例),比较两组患者临床基线资料,PPCI术中及术后相关数据,30d主要不良心血管事件(MACE)发生率。结果:与无绕行组比较,绕行组患者首次医疗接触至球囊扩张(FMC-to-B)时间显著缩短[(83.2±20.2)min比(74.5±15.5)min],术后肌酸激酶同工酶(CK-MB)峰值[(398.5±107.1)μg/L比(350.1±91.5)μg/L]、心肌肌钙蛋白I峰值[(58.5±16.9)μg/L比(51.4±13.1)μg/L]、N端脑钠肽前体(NT-proBNP)[(1324.0±749.1)ng/L比(1027.2±511.6)ng/L]水平显著降低,左室射血分数[(52.1±7.7)%比(55.4±5.6)%]显著提高(P均<0.05)。绕行组总MACE发生率显著低于无绕行组(4.3%比18.2%,P=0.030)。结论:绕行急诊科可以缩短急性心肌梗死院内救治流程,疗效更好。

Objective:To explore influence of bypassing department of emergency(BDE)on therapeutic effect of emergency intervention in patients with acute anterior myocardial infarction(AAMI).Methods:According to BDE or not,a total of 102 AAMI patients undergoing primary percutaneous coronary intervention(PPCI)in our department were divided into bypassing group(n=47)and no bypassing group(n=55).Clinical baseline data,related data during and after PPCI,and incidence rate of major adverse cardiovascular events(MACE)within 30d were compared between two groups.Results:Compared with no bypassing group,there were significant reductions in first medical contact to balloon(FMC-to-B)time[(83.2±20.2)min vs.(74.5±15.5)min],postoperative creatine kinase isoenzyme-MB(CK-MB)peak value[(398.5±107.1)μg/L vs.(350.1±91.5)μg/L],cardiac troponin I peak value[(58.5±16.9)μg/L vs.(51.4±13.1)μg/L]and N terminal pro brain natriuretic peptide(NT-proBNP)[(1324.0±749.1)ng/L vs.(1027.2±511.6)ng/L],and significant rise in LVEF[(52.1±7.7)%vs.(55.4±5.6)%]in bypassing group,P<0.05 all.Total incidence rate of MACE in bypassing group was significantly lower than that of no bypassing group(4.3%vs.18.2%),P=0.030.Conclusion:Bypassing department of emergency can shorten in-hospital rescue process of AMI,and bring patients more effect.