基层版胸痛中心在急性ST段抬高型心肌梗死救治中应用价值的单中心报告

A single center report on the usefulness of chest pain center in a county hospital on the treatments of acute ST-segment elevation myocardial infarction

目的通过回顾深泽县医院胸痛中心认证前后急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)的救治效果,探讨基层版胸痛中心在STEMI救治中的应用价值。方法回顾分析2017年1月至2018年7月深泽县医院收治并上报胸痛中心数据库的STEMI病例96例。根据胸痛中心通过认证的时间(2018年1月),将上报病例分别按认证前后STEMI救治流程进行诊断、治疗和转运。比较胸痛中心认证前后收治患者胸痛中心质量控制的核心数据:发病至首次医疗接触(?rst medical contact,FMC)时间、通过120急救车入院比例、FMC至首份心电图时间、心电图确诊时间、心电图传输比例、肌钙蛋白I(troponin I,cTnI)检测时间、FMC至抗凝和抗血小板时间、再灌注治疗比例、进门-溶栓时间、溶栓患者进门-出门时间、2~24 h转院比例等。随访患者住院期间和出院1个月时主要心脏不良事件(major adverse cardiac events,MACE)的发生情况。结果 2017年1月至2018年7月,累计收治STEMI患者96例,胸痛中心认证前45例,认证后51例。胸痛中心认证后STEMI患者心电图传输比例增加,FMC至首份心电图时间有缩短趋势,但差异均无显著性(P_均> 0.05),cTnI检测时间[(20.79±9.26)min∶(15.70±2.11)min,P <0.001]及FMC至抗凝和抗血小板时间较认证前均明显缩短(P_均<0.05)。溶栓患者进门-溶栓时间[(32.71±15.44) min∶(21.78±8.66)min,P <0.001]、溶栓后2~24 h内转运比率(47.4%∶94.3%,P <0.001)以及进门-出门时间[(8.31±6.95)h∶(2.81±2.40)h,P <0.001]均明显缩短。认证后经协作医院造影确认的溶栓再通比率为91.3%。胸痛中心认证前后收治患者心肌损伤标志物峰值、左心室射血分数、住院期间和随访期间MACE发生情况均无明显差异(P_均> 0.05)。结论胸痛中心建设可以显著改进基层医院STEMI救治流程,但是对STEMI救治效果的影响尚待进一步观察。

Objective To investigate the usefulness of chest pain center(CPC) in Shenze County Hospital on the treatments of ST-segment elevation myocardial infarction(STEMI). Method Retrospective analysis was performed on 96 cases of STEMI admitted to Shenze County Hospital and reported to the database of chest pain center from January 2017 to July 2018. According to the time of the authentication, all the patients were divided into pre-authentication group and post-authentication group. The two groups of patients were diagnosed, treated and transferred according to the STEMI treatment process before and after certi?cation. The data were recorded and compared including: time from symptom onset to ?rst medical contact(FMC), rate of the use of ambulance, time from FMC to electrocardiography(ECG), time of diagnose of ECG, rate of ECG transfer, time of troponin I(cTnI) examination, time from FMC to anti-platelet and anticoagulation therapies, rate of reperfusion therapy, time from door to needle in patients accepted thrombolysis(D-N), in-out time in patients accepted thrombolysis, and transport within 2-24 hours after thrombolysis. Major adverse cardiac events(MACE) were followed up during hospitalization and 1 month after discharge. Result A total of 96 cases with STEMI were enrolled, with 45 cases in pre-authentication group and 51 cases in post-authentication group. The baseline characteristics were similar between the two groups. After CPC authentication, the ratio of ECG transfer increased, and there was a short trend in the time from FMC to ECG, but the differences were not signi?cant(Pall> 0.05). The duration of cTnI examination was signi?cantly shortened ((20.79±9.26) min ∶(15.70±2.11) min, P < 0.001)The time from FMC to anti-coagulation and anti-platelet therapies were shorter in the post-authentication group(Pall< 0.05). The time of D-N [(32.71±15.44) min ∶(21.78±8.66) min,P < 0.001], in-out time[(8.31±6.95) h ∶(2.81±2.40) h, P < 0.001], and the ratio of transfer within 2-24 hours after thrombolysis(47.4% ∶ 94.3%, P < 0.001) were all shortened. The successful rate of thrombolysis was 91.3% according to the results of CAG.No significant differences were found in the levels of myocardial injury biomarkers and LVEF. The incidences of MACE during hospitalization and 1 month after discharge were similar between the two groups(Pall> 0.05). Conclusion The construction of CPC can improve the process of the treatments of STEMI in a county hospital, but the effects of CPC should be further studied.