胸痛中心持续改进机制对急性ST段抬高型心肌梗死患者救治效率及近期预后的影响

Effects of continuous improvement mechanism of chest pain center on treatment efficiency and short-term prognosis of patients with acute ST-segment elevation myocardial infarction

目的探讨胸痛中心持续改进机制对急性ST段抬高型心肌梗死(STEMI)患者救治效率及近期预后的影响。方法回顾性分析2018年3月至2020年2月东南大学医学院附属南京同仁医院接受直接经皮冠状动脉介入治疗(PPCI)的105例STEMI患者的临床资料,将2018年3月至2019年2月我院胸痛中心刚成立后1年收治的53例STEMI患者作为对照组,2019年3月至2020年2月经胸痛中心持续改进后收治的52例STEMI患者作为观察组。比较两组的胸痛中心关键认证指标及30 d主要心血管不良事件发生情况。结果观察组的首份心电图确诊时间、导管室激活时间、首次医疗接触到导丝通过时间均短于对照组,网络医院转诊比例、院前心电图传输比例、绕行急诊比例均高于对照组,差异具有统计学意义(P<0.05)。观察组的30 d主要心血管不良事件总发生率低于对照组,差异具有统计学意义(P<0.05)。结论胸痛中心持续改进机制能缩短STEMI患者院内救治时间,降低30 d主要心血管不良事件发生率,改善患者预后。

Objective To investigate the effects of continuous improvement mechanism of chest pain center on treatment efficiency and short-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The clinical data of 105 patients with STEMI who underwent primary percutaneous coronary intervention(PPCI)in Nanjing Tongren Hospital Affiliated to Southeast University School of Medicine from March 2018 to February 2020 were retrospectively analyzed,53 STEMI patients admitted in the chest pain center from March 2018 to February 2019 of our hospital one year after its establishment were taken as the control group,and 52 STEMI patients admitted in the chest pain center from March 2019 to February 2020 of our hospital after continuous improvement were taken as the observation group.The key certification indexes of chest pain center and the occurrence of major cardiovascular adverse events in 30 d were compared between the two groups.Results The first electrocardiogram diagnosis time,catheter room activation time,and first medical contact to guide wire passing time in the observation group were shorter than those in the control group,the proportion of network hospital referral,the proportion of pre-hospital electrocardiogram transmission,and the proportion of bypass emergency were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of major adverse cardiovascular events at 30 d in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The continuous improvement mechanism of chest pain center can shorten the in-hospital treatment time of STEMI patients,reduce the incidence of major cardiovascular adverse events within 30 d,and improve the prognosis of patients.