BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that ...BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.展开更多
Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial in...Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.展开更多
目的探讨宿迁地区基层胸痛中心发病至送达胸痛中心大门(symptom onset to door,StoD)时间的影响因素及对策。方法选择2022年1月—2023年6月宿迁市中西医结合医院胸痛中心收治的81例急性心肌梗死患者为研究对象。根据患者StoD时间分为≤...目的探讨宿迁地区基层胸痛中心发病至送达胸痛中心大门(symptom onset to door,StoD)时间的影响因素及对策。方法选择2022年1月—2023年6月宿迁市中西医结合医院胸痛中心收治的81例急性心肌梗死患者为研究对象。根据患者StoD时间分为≤6 h组50例与>6 h组31例。统计人口学资料以及相关影响因子,利用单因素分析与多因素logistic回归分析胸痛中心StoD时间的影响因素。结果2组疼痛程度评分、通过120入院还是自行来院、社区医生是否通过网络将心电图结果传输至胸痛中心、发病症状是否典型、家属态度是否积极、有无心血管疾病危险因素、是否夜间发病、发病地点与就诊医院的距离等指标比较,差异有统计学意义(P<0.05)。单因素分析及多因素logistic回归分析显示,自行来院、发病症状不典型、有心血管疾病危险因素、夜间发病、发病地点与就诊医院距离远均是胸痛中心StoD时间的危险因素,家属态度积极为保护因素(P<0.05)。结论基层胸痛中心StoD时间受患者来院途径、症状表现以及发病时间等影响,而家属积极态度有利于缩短StoD时间,需提高家属对疾病的认识,发挥区域诊疗中心协同救治的作用,缩短StoD时间及提高救治效率。展开更多
目的探究标准化急诊预检分诊模式在区域性胸痛中心中的应用价值。方法选取2020年7月—2022年1月陆军第七十三集团军医院未实施标准化急诊预检分诊模式时间段内接诊的100例急性胸痛患者设为对照组,将2022年2月—2023年6月陆军第七十三集...目的探究标准化急诊预检分诊模式在区域性胸痛中心中的应用价值。方法选取2020年7月—2022年1月陆军第七十三集团军医院未实施标准化急诊预检分诊模式时间段内接诊的100例急性胸痛患者设为对照组,将2022年2月—2023年6月陆军第七十三集团军医院开展标准化急诊预检分诊模式后接诊的100例急性胸痛患者为研究组。对比2组患者抢救指标、临床效果、急诊工作效率以及不良反应发生情况差异。结果研究组患者的预检分诊时间[(2.03±0.21)minvs.(3.05±0.29)min]、首份心电图时间[(5.06±1.01)minvs.(6.23±1.51)min]、开放静脉通路时间[(9.11±2.01)minvs.(11.63±2.01)min]、床旁测试(point-of-care-testing,POCT)+检验报告时间[(18.98±2.65)min vs.(23.65±2.81)min]均明显短于对照组(P<0.05)。研究组患者的首次医疗接触(first medical contact,FMC)至经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)(FMC-to-B)[(43.20±3.65)minvs.(56.96±5.18)min]、自送到医院至接受正规治疗总时间(total time from hospital to receiving formal treatment,D-to-B)[(72.36±6.23)min vs.(110.15±13.23)min]以及肌钙蛋白Ⅰ获得时间[(21.02±2.65)minvs.(31.05±3.11)min]均显著低于对照组(P<0.05)。研究组患者的急诊处置时间[(10.23±2.09)min vs.(16.32±3.01)min]以及急诊候诊时间[(0.98±0.31)min vs.(3.55±0.59)min]均明显短于对照组(P<0.05)。2组患者在预检分诊准确率比较,差异无统计学意义(P>0.05)。研究组患者出现心律失常1例,心力衰竭1例,不良反应总发生率为2.00%(2/100),显著低于对照组患者的9.00%(9/100)(P<0.05)。结论对急性胸痛患者开展标准化急诊预检分诊模式有助于提高患者预检分诊效率、改善临床治疗效果,对降低不良反应发生率具有积极意义。展开更多
基金Supported by the National Natural Science Foundation of ChinaNo. 82000252
文摘BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.
文摘Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.
文摘目的探究标准化急诊预检分诊模式在区域性胸痛中心中的应用价值。方法选取2020年7月—2022年1月陆军第七十三集团军医院未实施标准化急诊预检分诊模式时间段内接诊的100例急性胸痛患者设为对照组,将2022年2月—2023年6月陆军第七十三集团军医院开展标准化急诊预检分诊模式后接诊的100例急性胸痛患者为研究组。对比2组患者抢救指标、临床效果、急诊工作效率以及不良反应发生情况差异。结果研究组患者的预检分诊时间[(2.03±0.21)minvs.(3.05±0.29)min]、首份心电图时间[(5.06±1.01)minvs.(6.23±1.51)min]、开放静脉通路时间[(9.11±2.01)minvs.(11.63±2.01)min]、床旁测试(point-of-care-testing,POCT)+检验报告时间[(18.98±2.65)min vs.(23.65±2.81)min]均明显短于对照组(P<0.05)。研究组患者的首次医疗接触(first medical contact,FMC)至经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)(FMC-to-B)[(43.20±3.65)minvs.(56.96±5.18)min]、自送到医院至接受正规治疗总时间(total time from hospital to receiving formal treatment,D-to-B)[(72.36±6.23)min vs.(110.15±13.23)min]以及肌钙蛋白Ⅰ获得时间[(21.02±2.65)minvs.(31.05±3.11)min]均显著低于对照组(P<0.05)。研究组患者的急诊处置时间[(10.23±2.09)min vs.(16.32±3.01)min]以及急诊候诊时间[(0.98±0.31)min vs.(3.55±0.59)min]均明显短于对照组(P<0.05)。2组患者在预检分诊准确率比较,差异无统计学意义(P>0.05)。研究组患者出现心律失常1例,心力衰竭1例,不良反应总发生率为2.00%(2/100),显著低于对照组患者的9.00%(9/100)(P<0.05)。结论对急性胸痛患者开展标准化急诊预检分诊模式有助于提高患者预检分诊效率、改善临床治疗效果,对降低不良反应发生率具有积极意义。
