固定急救反应团队联合急救程序化管理对老年急性心肌梗死救治效果的影响

Effects of fixed emergency response team combined emergency procedural management on treatment effectiveness of elderly patients with acute myocardial infarction

目的探讨固定急救反应团队联合急救程序化管理对老年急性心肌梗死救治效果的影响,为治疗该病症提供方法。方法前瞻性选取2021年12月—2022年12月期间空军军医大学第一附属医院收治的老年急性心肌梗死患者105例,以固定急救反应团队联合急救程序化管理方案在本院推行时间(2022年6月)为截点,分为对照组(2021年12月—2022年5月)55例与观察组(2022年6月—2022年12月)50例,其中对照组予以传统急救模式干预,观察组予以固定急救反应团队联合急救程序化管理模式。比较2组急救成功率、急救时间(首诊时间、120到达时间、病情评估、静脉建立、心电图时间)、急诊治疗指标值(球囊时间、支架置入时间、急诊停留时间、住院时间)。于急救前后比较2组患者基本生命体征(呼吸、心率、血压)。于干预期间比较2组用药情况及并发症(心力衰竭、休克、胸痛、心律失常)。于干预前及干预1个月后比较2组患者血清相关指标值[脑钠肽(BNP)、心肌肌钙蛋白T(cTnI)、肌酸激酶同工酶(CK-MB)]、超声心动图参数[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)、左心室射血分数(LVEF)],记录其急救结束后生命质量[生命质量测定量表(WHOQOL-BREF)]评分结果。结果观察组死亡病例2例,剩余有效病例48例,对照组死亡病例15例,剩余有效病例40例,且观察组抢救成功率明显高于对照组(P<0.05);观察组急救时间、急诊治疗指标值、生命质量评分明显高于对照组(P<0.05)。急救后,2组的呼吸、心率、血压均较急救前下降,且观察组明显低于同期对照组(P<0.05)。干预1个月后,观察组血清相关指标、超声心动图参数(E/A、LVESD)明显低于同期对照组(P<0.05),LVEF明显高于同期对照组(P<0.05);观察组并发症发生率明显低于对照组(P<0.05);2组患者用药情况差异无统计学意义(P>0.05)。结论固定急救反应团队联合急救程序化管理对老年急性心肌梗死救治效果显著提高,可有效缩短急救时间,改善患者生命质量,预后较好,具有一定临床应用价值。

Objective To explore the effects of fixed emergency response team combined emergency procedural management on the treatment effectiveness of elderly patients with acute myocardial infarction.Methods A total of 105 elderly patients with acute myocardial infarction admitted to First Affiliated Hospital of Air Force Military Medical University from December 2021 to December 2022 were prospectively selected.According to the implementation time(June 2022)of fixed emergency response team combined emergency procedural management scheme in this hospital,55 cases were divided into the control group(December 2021-May 2022)and 50 ones were divided into the observation group(June 2022-December 2022).The control group received traditional emergency model intervention,while the observation group received fixed emergency response team combined emergency procedural management model intervention.The success rate of emergency treatment,emergency response time(first diagnosis time,120 arrival time,condition assessment,venous channel establishment,electrocardiogram time)and emergency treatment indexes(balloon time,stent placement time,emergency stay time,and hospital stay time)were compared between the two groups.Basic vital signs(respiration,heart rate,blood pressure)were compared between the two groups before and after emergency treatment.The medication use and complications(heart failure,shock,chest pain,arrhythmia)during the intervention period were compared between the two groups.Before intervention and 1 month after intervention,serum related indicators[brain natriuretic peptide(BNP),cardiac troponin T(cTnI),creatine kinase isoenzyme(CK-MB)],and echocardiographic parameters[early/late diastolic maximal blood flow velocity(E/A),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF)]were compared between the two groups.The scoring results of the quality of life(WHOQOL-BREF)of patients after emergency treatment were recorded.Results There were 2 deaths and the remaining 48 cases were effective in the observation group.There were 15 deaths and the remaining 40 cases were effective in the control group.The success rate of rescue in the observation group was significantly higher than that in the control group(P<0.05).The emergency response time,emergency treatment indexes and quality of life score of the observation group were significantly higher than those of the control group(P<0.05).After emergency treatment,the respiration,heart rate and blood pressure of both groups were lower than those of the same group before the treatment,and the observation group was significantly lower than the control group(P<0.05).After one month of intervention,the serum related indexes and echocardiographic parameters(E/A,LVESD)of the observation group were significantly lower than those of the control group(P<0.05),and LVEF was significantly higher than that of the control group(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).There was no statistically significant difference in medication use between the two groups(P>0.05).Conclusion The combination of fixed emergency response team and emergency procedural management has a significant effect on the treatment of acute myocardial infarction in the elderly.It can effectively shorten the emergency response time,improve the quality of life and prognosis of patients,which has certain clinical application value.