摘要
目的分析胸痛中心建设初期不同来院途径急性ST段抬高性心肌梗死(STEMI)患者再灌注时间的差异,找出今后需要着力改进的诊疗环节。方法回顾性分析210例行急诊冠状动脉(冠脉)介入治疗(PPCI)STEMI患者的临床资料,根据来院途径的不同方式分为120组(43例)、转院组(60例)及自行来院组(107例)。记录再灌注的关键时间点:患者发病时间、首次医疗接触(FMC)时间、至医院大门时间、球囊扩张时间,并统计分析三组再灌注时间的差异。结果转院组门-球时间43 min最短,自行来院组88 min最长,三组比较差异有统计学意义(P<0.05);自行来院组发病-FMC时间175 min相对最长,与其他两组比较差异有统计学意义(P<0.05),120组与转院组比较差异无统计学意义(P>0.05);转院组FMC-球囊时间249 min最长,与其他两组比较差异有统计学意义(P<0.05),120组与自行来院组比较差异无统计学意义(P>0.05);转院组发病-球囊时间394 min最长,与其他两组比较差异有统计学意义(P<0.05),120组与自行来院组比较差异无统计学意义(P>0.05)。总平均门-球时间76 min、发病-FMC时间141 min、FMC-球囊时间110 min、发病-球囊时间303 min。结论门-球时间不能完全代表STEMI救治的能力,发病-球囊时间才是衡量地区STEMI救治的真实水平,胸痛中心建设应以建立区域协同救治体系、提高社区居民的健康意识,最终缩短患者发病后的总缺血时间为目的。
Objective To analyze the difference of reperfusion time in patients with acute ST segment elevation myocardial infarction（STEMI） by different approaches to hospital during the early stage of chest pain center, and find out diagnosis and treatment links that need to be improved in the future. Methods The clinical data of 210 cases of emergency primary percutaneous coronary intervention（PPCI） STEMI patients was retrospectively analyzed. All patients were divided by different approaches to hospital into 120 group（43 cases）, hospital transfer group（60 cases） and hospital self-coming group（107 cases）. The key time points of reperfusion were recorded： the onset time of patients, first medical contact time（FMC）, time of hospital access and time of balloon expansion, and the difference of reperfusion time between the three groups was statistically analyzed. Results Hospital transfer group had shortest door-to-balloon time as 43 min, and hospital self-coming group had longest time as 88 min, and the difference was statistically significant（P〈0.05）. Hospital self-coming group had longest onset-to-FMC time as 175 min, and it had statistically significant difference comparing with other two groups（P〈0.05）. There was no statistically significant difference between 120 group and hospital transfer group（P〈0.05）. Hospital transfer group had longest FMC-to-balloon time as 249 min, and it had statistically significant difference comparing with the other two groups（P〈0.05）. 120 group had no statistically significant difference comparing with hospital self-coming group（P〉0.05）. Hospital transfer group had longest onset-toballoon time as 394 min, and it had statistically significant difference comparing with the other two groups（P〈0.05）. 120 group had no statistically significant difference comparing with hospital self-coming group（P〉0.05）. Patients had average of total door-to-balloon time as 76 min, onset-to-FMC time as 141 min, FMC-to-balloon time as 110 min and onset-balloon time as 303 min. Conclusion Door-to-balloon time can not fully represent the ability of STEMI treatment, and onset-balloon time is the true measure of the level of STEMI treatment. The construction of chest pain center should aim at establishing a regional collaborative treatment system, improving community residents＇ health consciousness, and ultimately reducing the total ischemia time after onset.
作者
陈慧生
陈宇
蒋芳勇
陶林
沈丽
黎荣山
CHEN Hui-sheng, CHEN Yu, JIANG Fang-yong, et al.(Liuzhou People＇ s Hospital, Liuzhou 545000, Chin)
出处
《中国实用医药》
2018年第9期19-21,共3页
China Practical Medicine
基金
柳州市科学研究与技术开发计划课题(项目编号:2016G030101)
关键词
来院途径
心肌梗死
再灌注时间
血管成形术
胸痛中心
Approaches to hospital
Myocardial infarction
Reperfusion time
Angioplasty
Chest pain center
