新型冠状病毒肺炎疫情管控对诊治急性ST段抬高心肌梗死患者的影响

Effects of the control measures for COVID-19 on diagnosis and treatment of patients with acute ST-segment elevation myocardial infarction

目的探讨新型冠状病毒肺炎(COVID-19)疫情管控对诊治急性ST段抬高心肌梗死(STEMI)患者的影响。方法选取我院2019年2月至3月非COVID-19流行期收治的STEMI患者37例(A组)、2020年2月至3月COVID-19流行初期收治的STEMI患者23例(B组)、2020年4月至5月COVID-19防控措施有效落实期间收治的STEMI患者32例(C组)进行观察比较。包括患者发病至首次医疗接触时间、入门-球囊扩张时间、总缺血时间的差异,以及左室舒张末内径(LVEDD)、左室射血分数(LVEF)、B型脑钠肽前体(BNP前体)、肌酸激酶同工酶(CKMB)、肌钙蛋白T等指标在围术期的变化等。结果发病至首次医疗接触时间,A组143 min,B组298 min,C组130 min,B组时间明显延迟(P<0.05);入门-球囊扩张时间,A组108 min,B组96 min,C组97 min钟,三组差异无统计学意义(P>0.05);总缺血时间,A组242 min,B组318 min,C组222 min,B组最长,但差异无统计学意义(P>0.05)。就诊心率,A组76.3次/min,B组85.0次/min,C组70.0次/min,B组心率明显更快(P<0.05)。LVEDD,B组(5.3 cm)大于A组(5.0 cm)(P<0.05)。白细胞数和中性粒细胞比例,A组10.6×10^(9)/L、70.3%,B组12.1×10^(9)/L、79.5%,C组9.7×10^(9)/L、67.3%,B组明显更高。结论COVID-19流行初期STEMI患者就诊时间明显延迟,就诊心率更快,左室扩大更显著,炎性指标更高。COVID-19防控措施的有效落实,救治流程得到优化,但有进一步改进。

Objective To explore the effects of novel COVID-19 epidemic on the diagnosis and treatment of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Thirty-seven cases of STEMI patients admitted to our hospital from February to March 2019 during non-COVID-19 epidemic period(Group A),23 cases of STEMI patients admitted to our hospital during February to March 2020 during the initial COVID-19 epidemic period(Group B),and 32 cases of STEMI patients admitted to our hospital during April to May 2020 during the effective implementation of COVID-19 prevention and control measures(Group C)were selected for observation and comparison.The differences in time from onset to first medical contact,entry-balloon dilation time,total ischemic time,as well as the perioperative changes of left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),B-type brain natriuretic peptide precursor(BNP precursor),creatine kinase isoenzyme(CKMB),troponin T,etc.Results The time from onset to first medical contact was 143 minutes in Group A,298 minutes in Group B and 130 minutes in Group C,and the time in Group B was obviously delayed(P<0.05).The entry-balloon expansion time was 108 min in group A,96 min in group B and 97 min in group C,and there was no significant difference among the three groups(P>0.05).Total ischemia time was 242 minutes in group A,318 minutes in group B,222 minutes in group C,and ischemia time of group B was the longest,but there was no statistical difference(P>0.05).The heart rate was 76.3 beats/min in group A,85.0 beats/min in group B and 70.0 beats/min in group C.The heart rate of group B was obviously faster(P<0.05).LVEDD of group B(5.3 cm)was larger than that in group A(5.0 cm)(P<0.05).The white blood cell count and neutrophil ratio were 10.6×10^(9)/L and 70.3%in group A,12.1×10^(9)/L and 79.5%in group B,9.7×10^(9)/L and 67.3%in group C,which was significantly higher in group B.Conclusion At the early stage of COVID-19 epidemic,STEMI patients had significantly delayed treatment time,faster heart rate,more significant left ventricular enlargement,and higher inflammatory indexes.The effective implementation of prevention and control measures in novel coronavirus has optimized the treatment process,but there is room for further improvement.