摘要
目的:通过分析中国最早以区域协同救治体系为依托的胸痛中心数据,评价胸痛中心建设对行直接经皮冠状动脉介入治疗(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者的救治时间和院内死亡率的影响。方法:从2010年1月1日至2017年12月31日,南部战区总医院共收治了STEMI患者2782例,其中有1570例接受了PPCI的患者符合入选条件,根据不同年份,将患者分为8个组(2010组~2017组),比较不同年份患者的救治时间及院内死亡率的变化。结果:8组患者在性别、年龄、高血压史、罪犯血管、住院天数及住院费用等方面差异无明显统计学意义(P>0.05)。8组患者从发病到首次医疗接触时间(S-to-FMC)自2010年的116 min降至2017年的85 min(P=0.247);患者的首次医疗接触到球囊扩张时间(FMC-to-B)从2010年的264 min降至2017年的163 min(P<0.001);患者的进门到球囊扩张时间(D-to-B)从2010年的109 min降至2017年的43 min(P<0.001);患者从发病到球囊开通血管(总缺血)时间(S-to-B)自2010年的402 min降至2017年的285 min(P<0.001)。胸痛中心成立后,患者的院内心力衰竭发生率从2011年的25.6%下降至2017年的22.2%(P<0.001);患者的院内死亡率明显下降,从2010年的10.7%下降至2017年的3.4%(P<0.001)。结论:区域协同救治体系下,胸痛中心模式显著缩短了接受PPCI的STEMI患者的救治时间,尤其是显著缩短了PPCI院内救治时间和医疗系统的延误,从而有效降低了STEMI患者的心力衰竭发生率及院内死亡率。未来应加强公众教育缩短发病到首次医疗接触时间;同时强化基层医院培训教育,缩短转诊延误。
Objectives:To assess the impact of the establishment of chest pain center(CPC)on the treatment efficiency and inhospital mortality of patients with acute ST-segment elevation myocardial infarction(STEMI)receiving primary percutaneous coronary intervention(PPCI)in China by analyzing a database from the first CPC in China.Methods:We established the first CPC in the year of 2011 in China.A total of 2782 STEMI patients were treated at our hospital between January 1,2010,and December 31,2017.A total of 1570 patients who received PPCI and met the inclusion criteria of this study were divided into eight groups according to the year of admission to compare the treatment efficiency and in-hospital mortality over the study period.Results:No significant differences were observed in sex,age,history of hypertension,culprit vessels,length of hospital stay,or cost among the eight groups(P>0.05).The symptom-onset-to-first-medical-contact(S-to-FMC)time decreased significantly from 116 minutes in 2010 to 85 minutes in 2017(P=0.247),the FMC-to-balloon(FMC-to-B)time decreased significantly from 264 minutes in 2010 to 163 minutes in 2017(P<0.001),the door-to-balloon(D-to-B)time decreased significantly from 109 minutes in 2010 to 43 minutes in 2017(P<0.001),and the symptom-onset-to-balloon(S-to-B)time decreased significantly from 402 minutes in 2010 to 285 minutes in 2017(P<0.001).Moreover,the overall incidence of inhospital heart failure decreased significantly from 25.6%in 2011 to 22.2%in 2017(P<0.001),and the in-hospital mortality was significantly decreased from 10.7%in 2010 to 3.4%in 2017(P<0.001).Conclusions:Under the regional cooperative rescue system,the CPC model could significantly reduce the time to treatment and markedly reduce the hospital treatment time of PPCI and medical system delays,thereby effectively reduce the incidence of heart failure and in-hospital mortality of STEMI patients.In the future,we should strengthen public education to reduce the S-to-FMC time and strengthen the training and education of primary hospitals to shorten the treatment delay caused by interhospital transfer.
作者
孔冉冉
龙锋
易绍东
张金霞
顾晓龙
向定成
KONG Ranran;LONG Feng;YI Shaodong;ZHANG Jinxia;GU Xiaolong;XIANG Dingcheng(Department of Cardiology,General Hospital of Southern Theatre Command of PLA,Guangzhou(510010),Guangdong,China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第1期39-44,共6页
Chinese Circulation Journal
基金
国家重点研发计划(2016YFC1301201)
广州市科技计划项目(202002020036)
心血管健康联盟基金(2017-CCA-VG-032)。
关键词
胸痛中心
区域协同救治体系
ST段抬高型心肌梗死
院内死亡率
chest pain center
regional cooperative rescue system
ST-segment elevation myocardial infarction
in-hospital mortality
