基于专科医联体的标准版-基层版胸痛中心体系对ST段抬高型心肌梗死患者救治效果的影响

Impact of standard-basic version of chest pain center system based on specialist medical alliance on treatment of patients with ST-segment elevation myocardial infarction

目的探讨基于专科医联体的标准版-基层版胸痛中心体系与普通区域救治体系对急性ST段抬高型心肌梗死(STEMI)患者救治效果的影响。方法嘉兴学院附属第二医院通过国家胸痛中心(标准版)认证之后,与其中一家网络医院建立心血管专科医联体,并帮扶其建设基层版胸痛中心,成立标准版-基层版胸痛中心体系。回顾该体系(2017年2月至2019年12月)转运经皮冠状动脉介入治疗(PCI)的STEMI患者作为观察组(40例),回顾同时段的其他10余家网络医院转运PCI的STEMI患者为对照组(121例)。对比两组患者总缺血时间、首次医疗接触(FMC)时间、网络医院入门至转出(DIDO)时间、FMC-导丝通过(FMC-to-W)时间、大门-导丝通过(D-to-W)时间及达标率,绕行急诊比例,院内心力衰竭、死亡率,住院天数及费用。结果观察组DIDO时间[(52.35±46.07)min比(77.15±76.75)min,P=0.015]、D-to-W时间[(60.98±27.31)min比(71.35±24.65)min,P=0.026]均短于对照组,但途中转运时间[(52.45±6.08)min比(41.56±11.37)min,P=0.001]长于对照组,差异均有统计学意义。两组患者FMC-to-W时间、住院天数、住院费用比较,差异均无统计学意义(均P>0.05)。观察组患者的绕行急诊比例(40.0%比11.6%,P<0.001)、DIDO 30 min达标率(37.5%比11.6%,P<0.001)均高于对照组,差异均有统计学意义。两组患者院内90 min再灌注率、FMC-to-W 120 min达标率、院内心力衰竭发生率和死亡率比较,差异均无统计学意义(均P>0.05)。结论基于专科医联体的标准版-基层版胸痛中心体系,能够提高心肌梗死的区域协同救治能力和运行效果,且质量优于普通的胸痛中心救治体系。

Objective This study intends to investigate the effect of standard-basic version of chest pain center system based on specialist medical alliance on the treatment effect of patients with ST-segment elevation myocardial infarction(STEMI).Methods After chest pain center accreditation(standard version),Jiaxing second Hospital established cardiovascular specialist medical alliance together with one of the network hospitals,and help to build basic version chest pain center,as standard-basic version chest pain center system.A total of 40 patients with STEMI in the chest pain center system based on specialist medical alliance receiving transit PCI were enrolled as observation group(February 2017 to December 2019).Meanwhile,121 patients with STEMI in the ordinary chest pain center system with more than 10 other network hospitals receiving transit PCI were enrolled as control group.The total ischemia time,first medical contact(FMC)time,the door-in and door-out(DIDO)time,the FMC-wire(FMC-to-W)time,the door-to-wire(D-to-W)time,ratio of emergency bypass surgery,in-hospital heart failure,mortality rates,hospitalization days and expenses were compared between the two groups.Results Compared with control group,the DIDO time[(52.35±46.07)min vs.(77.15±76.75)min,P=0.015],D-to-W time[(60.98±27.31)min vs.(71.35±24.65)min,P=0.026]of observation group were signifi cant shorter,while the transfer time[(52.45±6.08)min vs.(41.56±11.37)min,P=0.001]were longer,both with signifi cance.The proportion of emergency bypass(40.0%vs.11.6%,P<0.001)and the rate of DIDO<30 min(37.5%vs.11.6%,P<0.001)in the observation group were higher than those in the control group.There were no significant differences.In 90 min reperfusion rate,120 min standard rate of FMC-to-W,incidence of heart failure or mortality between the two groups(all P>0.05).Conclusions The standard-basic version chest pain center system based on specialist medical alliance can improve regional cooperative therapeutic ability of myocardial infarction,and has better effi cacy and quality than ordinary chest pain center system.