摘要
目的观察优化急性心肌梗死(acute myocardial infarction,AMI)急诊路径管理对血管再通治疗的影响。方法回顾性分析了1995-01至2011-12共1134例ST段抬高型心肌梗死患者(ST segment elevation myocardial infarction,STEMI)急诊血管再通治疗情况及时间截点。分析在急性心肌梗死急诊路径管理下,患者急诊静脉溶栓和急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)逐年变化情况,及急诊静脉溶栓联合PCI治疗(易化PCI治疗)和直接PCI对临床的影响,分析患者发病-来诊时间、来诊-静脉溶栓时间(门-针时间)和来诊-急诊PCI时间(门-球时间)变化情况。自2004年进一步优化管理路径,取消心内科会诊,加强了时间截点管理等措施,分析优化前后变化情况。结果急诊PCI患者人数逐年增加,2004年急诊PCI患者人数开始多于静脉溶栓人数;患者发病-来诊时间17年间变化不大,患者来诊-静脉溶栓时间和来诊-急诊PCI时间2004年后有明显缩短。易化PCI不能降低住院病死率。结论急性心肌梗死急诊路径的实施,逐年缩短了急性心肌梗死患者来诊至救治时间,可以挽救濒死心肌,对急诊临床工作有很好的指导和帮助作用。易化PCI较直接PCI相比不能改善临床预后。
Objective To measure the effect of a clinical pathway on patients with acute myocardial infarction （AMI） in e mergency departments. Methods The effectiveness of a multidisciplinary clinical pathway for AMI patients over the past seventeen years in our emergency department was retrospectively analyzed. The clinical pathways used before 2004 and after 2004 were com pared. The measurement involed the time to room, time of door to needle, time of door to balloon. We also compared the effect of clinical outcomes of facilitated PCI （ venous thromblysis plus PCI, percutaneous coronary intervention ） and primary PCI. Results A total of 1134 ST segment elevation myocardial infarction （STEMI） patients were analyzed. The number of acute PCI patients in creased while the time of door to needle time and door to balloon decreased significantly since 2004. However, time to room didn＇ t change much. Facilitated PCI could not improve in hospital survival compared with the primary PCI. Conclusion The clini cal pathway can shorten the time of door to needle and door to balloon for AMI patients. Facilitated PCI fails to improve the clin ical outcomes when compared with primary PCI.
出处
《武警医学》
CAS
2012年第9期787-790,共4页
Medical Journal of the Chinese People's Armed Police Force
基金
北京市科委资助课题(编号:D0905002040511)
关键词
急诊路径
急性心肌梗死
门-针时间
门-球时间
clinical pathway
acute myocardial infarction
door to needle time
door - to - balloon time
