院内急救“3P”管理模式在经皮冠状动脉介入治疗老年急性心肌梗死中的应用

Application of 3P management mode of in-hospital emergency care in percutaneous coronary intervention for elderly patients with acute myocardial infarction

目的 探究院内急救“3P”管理模式在经皮冠状动脉介入治疗老年急性心肌梗死患者中的应用。方法 回顾性分析成都医学院第二附属医院·核工业四一六医院2017年6月—2021年6月收治的85例老年急性心肌梗死患者的临床资料,将实施院内急救“3P”管理模式护理的患者纳入观察组(n=40),实施常规急诊护理的患者纳入对照组(n=45)。观察并比较2组关键时间节点、心肌酶谱水平、超声心动图参数指标以及救治结局。结果 2组急诊医师首诊时间比较差异无统计学意义(P>0.05),观察组心内科医师会诊时间、患者在急诊科停留时间、导管室激活时间以及入院至行球囊扩张(D-to-B)时间均短于对照组(P<0.05)。干预前,2组心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)水平差异无统计学意义(P>0.05);干预后,2组cTnI、 CK-MB水平均下降,观察组低于对照组(P<0.05)。干预前,2组舒张早期/舒张晚期最大血流速度(E/A)、左室收缩末期内径(LVESD)以及左心室射血分数(LVEF)比较差异无统计学意义(P>0.05);干预后,2组E/A、 LVEF均上升,LVESD下降,观察组高于(低于)对照组(P<0.05)。2组住院病死率差异无统计学意义(P>0.05);观察组住院时间少于对照组,主要心血管不良事件(MACE)发生率低于对照组,心肌梗死溶栓治疗(TIMI)后的3级冠脉血流比例、 ST段抬高值下降幅度>50%的比例均高于对照组,差异均有统计学意义(P<0.05)。结论 院内急救“3P”管理模式在老年急性心肌梗死患者中的应用效果良好。

Objective To investigate the application of 3 P management mode of in-hospital emergency care in percutaneous coronary intervention for elderly patients with acute myocardial infarction. Methods The clinical data of 85 elderly patients with acute myocardial infarction admitted to Second Affiliated Hospital of Chengdu Medical College·416 Hospital of Nuclear Industry from June 2017 to June 2021 were retrospectively analyzed. Patients receiving “3 P” management mode of in-hospital emergency care were included in the observation group(n=40), and patients receiving routine emergency care were included in the control group(n=45).The key time points, myocardial enzyme levels, echocardiographic parameters and treatment outcomes of the two groups were observed and compared. Results There was no statistically significant difference in the first visit time of emergency physician between the two groups(P>0.05). The consultation time of cardiologists, the time of patients staying in the emergency department, the activation time of catheter room and the door-to-balloon(D-to-B) time in the observation group were shorter than those in the control group(P<0.05). There was no statistically significant difference in the levels of cardiac troponin(cTnI) and creatine kinase isoenzyme(CK-MB) between the two groups before intervention(P>0.05). After intervention, the levels of cTnI and CK-MB decreased in the two groups, and the levels of cTnI and CK-MB in the observation group were lower than those in the control group(P<0.05). There was no statistically significant difference in maximum early diastolic flow velocity/late diastolic flow velocity(E/A), left ventricular end systolic diameter(LVESD) and left ventricular ejection fraction(LVEF) between the two groups before intervention(P>0.05). After intervention, E/A and LVEF increased and LVESD decreased in both groups, and these indexes in the observation group were higher or lower than those in the control group(P<0.05). There was no statistically significant difference in the in-hospital mortality between the two groups(P>0.05). The length of hospital stay and the incidence of major adverse cardiovascular events(MACE) in the observation group were shorter or lower than those in the control group(P<0.05). The proportions of grade 3 coronary blood flow after thrombolytic therapy(TIMI) for myocardial infarction and ST segment elevation value decreasing by more than 50% in the observation group were higher than those in the control group(P<0.05). Conclusion “3 P” management mode of in-hospital emergency care has a good effect in elderly patients with acute myocardial infarction.