目的:研究胸痛中心网络医院建设对急性ST段抬高型心梗患者救治效率的影响。方法:选取我院2018年4月~2020年4月收治的236例急性ST段抬高型心梗患者作为研究对象,将胸痛中心网络医院转诊收治的患者列入实验组(n = 112),将自行入院收治的患者列入常规组(n = 124)。对比两组患者平均入门到导丝通过罪犯血管所需时间(D2W)、平均总缺血时间、平均住院时间、术中再灌注反应的出现比例、术后2 h内抬高的ST段回落>50%的比例;并对患者展开一年的随访,对比两组患者一年再住院率和主要心血管事件发生率(MACE)。结果:与常规组相比,实验组患者平均D2W时间、平均总缺血时间以及平均住院时间显著更短(P < 0.05);与常规组相比,实验组术中出现再灌注反应和术后2 h内抬高的ST段回落> 50%的比率显著更高(P < 0.05);常规组和实验组一年内再住院人数差异不具有统计学意义(P > 0.05);与常规组主要心血管事件发生率9.67% (12/124)相比,实验组0.89% (1/112)显著更低(P < 0.05)。结论:胸痛中心网络医院建设的创建能够有效提高对急性ST段抬高型心梗患者的救治效率。 Objective: To investigate influence of treatment network construction in chest pain center on the rescue quality for patients with acute ST-segment elevation myocardial in-farction. Methods: A total of 236 patients with acute ST-segment elevation myocardial infarction in our hospital from April 2018 to April 2020 were enrolled, including 112 referral patients (experi-mental group) and 124 outpatients (routine group). Various indexes were compared between the two groups, including average door-to-wire time (D2W), mean ischemia time, average length of hos-pital stay, incidence rate of reperfusion reaction, and proportion of ST segment elevation resolu-tion > 50% within 2 hours after surgery. All patients received one-year follow-up, and the rehospi-talization rate and the incidence of major adverse cardiovascular events (MACE) were recorded in both groups. Results: Compared with routine group, average D2W time, mean ischemia time and average hospital stay length were significantly shorter in experimental group (P < 0.05). The rate of reperfusion reaction during operation and ST segment elevation resolution > 50% within 2 hours after surgery were significantly lower in routine group than in study group (P < 0.05). The rehospi-talization rate displayed no significant difference between the two groups (P > 0.05). The incidence rate of MACE was 9.67% (12/124) in routine group, which was significantly higher than 0.89% (1/112) in experimental group (P < 0.05). Conclusion: Treatment network construction in chest pain center can effectively improve the efficacy rate of patients with acute ST-segment elevation myocardial infarction.
目的:研究胸痛中心网络医院建设对急性ST段抬高型心梗患者救治效率的影响。方法:选取我院2018年4月~2020年4月收治的236例急性ST段抬高型心梗患者作为研究对象,将胸痛中心网络医院转诊收治的患者列入实验组(n = 112),将自行入院收治的患者列入常规组(n = 124)。对比两组患者平均入门到导丝通过罪犯血管所需时间(D2W)、平均总缺血时间、平均住院时间、术中再灌注反应的出现比例、术后2 h内抬高的ST段回落>50%的比例;并对患者展开一年的随访,对比两组患者一年再住院率和主要心血管事件发生率(MACE)。结果:与常规组相比,实验组患者平均D2W时间、平均总缺血时间以及平均住院时间显著更短(P < 0.05);与常规组相比,实验组术中出现再灌注反应和术后2 h内抬高的ST段回落> 50%的比率显著更高(P < 0.05);常规组和实验组一年内再住院人数差异不具有统计学意义(P > 0.05);与常规组主要心血管事件发生率9.67% (12/124)相比,实验组0.89% (1/112)显著更低(P < 0.05)。结论:胸痛中心网络医院建设的创建能够有效提高对急性ST段抬高型心梗患者的救治效率。
胸痛中心网络医院建设,急性ST段抬高型心梗,救治效率,主要心血管事件
Gang Pan, Cheng Li, Mingxin Liu, Shengchun Long
Department of Cardiovascular Medicine, Yueyang Central Hospital, Yueyang Hunan
Received: Aug. 29th, 2022; accepted: Oct. 13th, 2022; published: Oct. 20th, 2022
Objective: To investigate influence of treatment network construction in chest pain center on the rescue quality for patients with acute ST-segment elevation myocardial infarction. Methods: A total of 236 patients with acute ST-segment elevation myocardial infarction in our hospital from April 2018 to April 2020 were enrolled, including 112 referral patients (experimental group) and 124 outpatients (routine group). Various indexes were compared between the two groups, including average door-to-wire time (D2W), mean ischemia time, average length of hospital stay, incidence rate of reperfusion reaction, and proportion of ST segment elevation resolution > 50% within 2 hours after surgery. All patients received one-year follow-up, and the rehospitalization rate and the incidence of major adverse cardiovascular events (MACE) were recorded in both groups. Results: Compared with routine group, average D2W time, mean ischemia time and average hospital stay length were significantly shorter in experimental group (P < 0.05). The rate of reperfusion reaction during operation and ST segment elevation resolution > 50% within 2 hours after surgery were significantly lower in routine group than in study group (P < 0.05). The rehospitalization rate displayed no significant difference between the two groups (P > 0.05). The incidence rate of MACE was 9.67% (12/124) in routine group, which was significantly higher than 0.89% (1/112) in experimental group (P < 0.05). Conclusion: Treatment network construction in chest pain center can effectively improve the efficacy rate of patients with acute ST-segment elevation myocardial infarction.
Keywords:Treatment Network Construction in Chest Pain Center, Acute ST-Segment Elevation Myocardial Infarction, Rescue Efficiency, Major Adverse Cardiovascular Events
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急性ST段抬高型心肌梗死(Acute ST-segment elevation myocardial infarction, STEMI)是一种发病快、进展快以及死亡率高的心血管危急重症,且近些年来发病率正逐年升高 [
选取我院2018年4月~2020年4月收治的236例STEMI患者作为研究对象,按照来院方式的不同将胸痛中心网络医院转诊的患者列入实验组(n = 112),将自行入院收治的患者列入常规组(n = 124),实验组112例,男性82例,女29例,年龄45~78岁,平均年龄(64.61 + 11.45)岁,合并基础疾病:高血压111例,糖尿病109例,高脂血症110例;常规组124例,男93例,女30例,年龄45~79岁,平均年龄(61.89 + 12.49)岁,合并基础疾病:高血压123例,糖尿病121例,高脂血症122例,两组患者一般资料年龄、性别、基础疾病史等差异不具有统计学意义(P > 0.05)。纳入标准:1) 患者符合《急性心肌梗死的诊断与治疗》 [
a) 患者同时合并急性脑血管意外、急性主动脉综合征、急腹症等危急重症;
b) 患者资料不完整;
本研究为观察性研究,已通过岳阳市中心医院伦理委员会批准。
常规组患者自行入我院急诊就诊,或拨打120由救护车送入我院急诊,急诊科医生询问病史及完善心电图检查做出初步诊断,心内科医师紧急会诊后做出手术决策,随后立即激活导管室,取得患者家属手术知情同意后,进入导管室接受急诊PCI手术治疗。
实验组:以我院作为急诊PCI中心医院,并联同附近二级医院及基层医院,创建胸痛救治沟通平台(包括微信群,24小时值守的胸痛中心联系电话)。网络医院医师初诊可疑STEMI患者后,将患者的病史、心电图、心肌标志物结果传送到胸痛中心微信群,同时第一时间电话联系我院胸痛中心,我院心内科医师根据病情做出手术决策,立即激活导管室,指导初诊医师给予负荷量双抗血小板等药物治疗,同时安排本院或外院救护车接病人至我院,120医师可在转运途中与家属进行手术预谈话,取得家属知情同意后可绕行急诊科直接入导管室行急诊PCI术,如病情复杂沟通不顺利则送入我院急诊科ICU,由我科医师沟通并取得知情同意后入介入室行急诊PCI术。
对比平均入门到导丝通过罪犯血管所需时间(D2W)、平均总缺血时间、平均住院时间、术中再灌注反应(包括再灌注心律失常和迷走反射)的出现比例、术后2 h内抬高的ST段回落 > 50%的比例;并对患者展开一年的随访,对比两组患者一年再住院率和主要心血管事件(MACE)发生率。
SPSS20.0进行统计分析。计量资料以( x ¯ ± s )的形式表示,组间采用独立样本t检验、组内均采用配对样本t检验;计数资料以“%”表示,组间比较采用χ2检验,记P < 0.05为差异具有统计学意义。
与常规组相比,实验组患者平均D2W、平均总缺血时间以及平均住院时间显著更短,差异具有统计学意义(P < 0.05)。见表1。
与常规组相比,实验组术中出现再灌注反应和术后2 h内抬高的ST段回落 > 50%的比率显著更高,差异具有统计学意义(P < 0.05)。见表2。
组别 | D2W | 平均总缺血时间 | 平均住院时间 |
---|---|---|---|
实验组(n = 112) | 40.99 + 5.44 | 409.48 + 10.81 | 9.10 + 1.21 |
常规组(n = 124) | 63.28 + 5.97 | 477.27 + 10.60 | 10.56 + 1.15 |
t | 29.869 | 24.519 | 9.500 |
P | <0.001 | <0.001 | <0.001 |
表1. 两组患者临床指标对比( x ¯ ± s , min)
组别 | 术中存在再灌注反应 | 术后2 h内ST段回落 > 50% |
---|---|---|
实验组(n = 112) | 33 (29.46) | 54 (49.10) |
常规组(n = 124) | 15 (12.09) | 31 (25.00) |
t | 8.980 | 13.761 |
P | 0.002 | <0.001 |
表2. 两组患者临床指标对比[n(%)]
常规组和实验组一年内再住院率差异不具有统计学意义(P > 0.05);与常规组MACE发生率9.67% (12/124)相比,实验组0.89% (1/112)显著更低差异具有统计学意义(P < 0.05)。见表3。
组别 | 一年内再住院 | MACE发生率 | |
---|---|---|---|
是 | 否 | ||
实验组(n = 112) | 22 (19.64) | 90 (72.50) | 1 (0.89) |
常规组(n = 124) | 26 (20.96) | 98 (79.03) | 12 (9.67) |
χ2 | 0.063 | 8.726 | |
P | 0.800 | 0.003 |
表3. 两组患者一年内再住院率和MACE发生率对比[n(%)]
STEMI是一种进展迅速的心血管危急重症,具有较高的死亡率和致残率,虽然诊疗技术特别是介入技术一直在进步,但近些年来其死亡率仍未见显著改善 [
我国目前许多医院仍不具备急诊PCI手术的基础和条件,所以多数患者仍存在救治不及时的情况。胸痛中心网络医院建设是一种协同救治模式,将有急诊PCI能力的区域医疗中心作为中心医院,并联同附近二级医院以及基层医院,创建相互沟通的胸痛救治体系 [
综上所述,胸痛中心网络医院的建设可提高各级医院之间沟通和协作的能力,有效提高对STEMI患者的救治效率,同时明显改善患者急性期及远期预后效果。
潘 港,李 诚,刘明鑫,龙胜春. 胸痛中心网络医院建设对急性ST段抬高型心梗患者救治效率的影响 Influence of Treatment Network Construction in Chest Pain Center on the Rescue Quality for Patients with Acute ST-Segment Elevation Myocardial Infarction[J]. 亚洲急诊医学病例研究, 2022, 10(02): 7-12. https://doi.org/10.12677/ACREM.2022.102002