胸痛中心建设对急性心肌梗死救治疗效的影响

Influence of chest pain center establishment on early rescue&treatment and prognosis of patients with acute myocardial infarction

目的:探讨胸痛中心成立对急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)患者的救治时间及早期预后的影响。方法:采用回顾性分析的方法,将北京市海淀医院胸痛中心成立前后各18个月就诊急诊科行急诊PCI的305例STEMI患者,分为胸痛中心成立前组(118例)和胸痛中心成立后组(187例)。比较两组总缺血时间、首次医疗接触时间至球囊扩张时间(FMC2B)、就诊至球囊扩张时间(D2B)等;FMC2B、D2B达标率;平均住院时间、心衰比例、住院死亡率的差异。根据是否是工作时间,两组分别分为工作时间组和非工作时间组,比较FMC2B、D2B达标率的差异。结果:与胸痛中心成立前组比较,胸痛中心成立后组总缺血时间[217(172.50,291.25)min比185(135.00,262.00)min]、FMC2B[129(105.00,165.50)min比97(77.00,133.50)min]、D2B[99(86.00,134.25)min比71(53.00,87.00)min]及平均住院时间[11(8.75,14.00)d比8(7.00,11.00)d]均显著缩短,心衰发生率(27.12%比14.44%)显著降低,FMC2B达标率(41.53%比68.45%)、D2B达标率(44.07%比79.68%)显著提高,P均<0.01;无论在工作时间还是非工作时间,胸痛中心成立后组FMC2B、D2B达标率均显著高于胸痛中心成立前组(P均<0.01)。结论:我院成立胸痛中心显著缩短了急诊STEMI救治时间,提高了救治效果。

Objective:To investigate influence of chest pain center(CPC)establishment on rescue time and early prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods:A total of 305 STEMI patients,who visited our department and underwent emergency PCI 18 months before and after our CPC establishment,were retrospectively divided into pre establishment group of chest pain center(n=118)and post establishment group of chest pain center(n=187).Total ischemia time,first medical contact to balloon time(FMC2B),door-to-balloon(D2B)etc.,target-reaching rates of FMC2B and D2B,mean in-hospital stay,percentage of heart failure and hospitalization mortality were compared between two groups.According to working hours(WH)or not,two groups were further divided into WH group and non-WH group,and target-reaching rates of FMC2B and D2B were compared between them.Results:Compared with pre establishment group of chest pain center,there were significant reductions in total ischemia time[217(172.50,291.25)min vs.185(135.00,262.00)min],FMC2B[129(105.00,165.50)min vs.97(77.00,133.50)min],D2B[99(86.00,134.25)min vs.71(53.00,87.00)min],mean in-hospital stay[11(8.75,14.00)d vs.8(7.00,11.00)d]and incidence rate of heart failure(27.12%vs.14.44%),and significant rise in target-reaching rates of FMC2B(41.53%vs.68.45%)and D2B(44.07%vs.79.68%)in post establishment group of chest pain center,P<0.01 all;whatever WH or not,target-reaching rates of FMC2B and D2B in post establishment group of chest pain center were significantly higher than those of pre establishment group of chest pain center,P<0.01 all.Conclusion:Our chest pain center establishment has significantly shorten rescue time of emergency STEMI,improve rescue effect.