摘要
目的观察区域化协同救治模式对急性冠脉综合征（ACS）救治的首次医疗接触到球囊扩张（FMC-to-B）时间、经济学指标及其预后的影响。方法入选非我院首诊的ACS患者（包括ST段抬高和非ST段抬高），发病时间在24h以内行急诊冠脉介入治疗，根据患者是否为“区域化协同救治”分为研究组和对照组。观察两组患者FMC-to-B时间、门-球（D-to-B）时间、转诊时间、心功能、平均住院日、住院费用及药占比等指标有无差别，并随访6个月观察主要不良心脏事件（MACE）。结果研究组FMC-to-B、D-to-B、转诊时间及获得知情同意时间均明显较对照组缩短[（106±33）min，（31±8）min，（624±18，8±3）min]vs．[（231±35）min，（109±26）min，（98±31）min，（28±11）min，研究组患者左室射血分数（EF％）及左室舒张末期内径（LVED）较对照组改善，研究组患者平均住院日[（8．7±4．1）dvs．（13．2±6．4）d]、住院费用[（44123．0±3427．0）vs．（51587．0±5621．0）元]及药占比（9．3％vs．11．2％）明显减少，研究组MACE事件为6．2％，对照组为16．8％。结论实施区域化协同救治可明显改善患者预后，缩短FMC-to-B时间，减少MACE事件，减轻患者经济负担。
Objective To evaluated the effect of the regional cooperative rescue model implemented on the length of time from first medical contact （ FMC ） to balloon dilation （ B ） , economic expense and prognosis in patients with acute coronary syndrome （ACS）. Methods Patients with ACS （including ST- segment elevation and non-ST-segment elevation） selected from other hospitals within 24 hours after onset were treated with emergency percutaneous coronary intervention. Patients were divided into two groups, ＂ regional cooperative rescue＂ group and control group without the regional cooperative rescue model approved. The lengths of FMC-to-B time and Door-to-B time （from arrival at emergency department or OPD to balloon dilation）, time required for patients referred to our hospital, cardiac function, averaged hospital costs, average hospital stay, percentage of medication used and a major adverse cardiac event （MACE） were analyzed. Results Mean FMC-to-B time, Door-to-B time, referral time and time consumed to obtain informed consent were significantly shorter [ （106±33） min, （31±8） min, （62±18, 8±3） min] vs. [ （231±35） min, （109 ±26） min, （98±31） min, （28 ± 11） min, respectively] by implementing the regional cooperative rescue compared with control group, and LVEF was increased, and LVED was deceased in ＂ regional cooperative rescue＂ group. The mean costs [ （44 123.0±3 427. 0） yuan vs. （51 587.0 ±5 621.0） ] yuan, days of hospital stay [ （8.7±4. 1 ） vs. （ 13.2±6. 4） ] and percentage of medication used were significantly decreased in the regional cooperative rescue group. The incidence of MACE in ＂ regional cooperative rescue＂ group was 6. 2% , whereas the incidence in control group was 16. 8%. Conclusions The regional cooperative rescue model can improve the prognosis and decrease the FMC-to-B time, the rate of MACE and financial burden in patients with ACS.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2015年第6期648-652,共5页
Chinese Journal of Emergency Medicine
基金
国家临床重点专科建设项目（2011）
中国医师协会阳光心血管研究基金（SCRFCMDA201303）江苏省创新团队基金（LJ201116）
江苏省333二层次项目（BRA2014162）
镇江市社会发展基金（SH2013078）
江苏省卫生厅社会发展基金（Q201308）
镇江‘市心血管病重点实验室（SS2012002）.
关键词
急性冠脉综合征
首次医疗接触
区域协同
预后
主要不良心在事件
门-球时间
经济学
救治
Acute coronary syndrome
First medical contact
Regional cooperative
Prognosis
Major adverse cardiac event
Door to balloon
Economics
Rescue
