摘要
目的探讨胸痛中心建设对急性ST段抬高型心肌梗死患者救治时间和院内不良事件发生率的影响。方法纳入2016年9月至2017年12月于河北省人民医院行直接经皮冠状动脉介入治疗的275例急性ST段抬高型心肌梗死患者。将通过胸痛中心认证前的121例患者设为对照组,通过胸痛中心认证后的154例患者设为研究组,比较两组患者入门至球囊扩张时间、首次医疗接触至球囊扩张时间、发病至首次医疗接触时间及院内主要不良心脑血管事件发生率,并对院内主要不良心脑血管事件发生的影响因素进行logistic回归分析。结果研究组患者入门至球囊扩张时间[51(34,65)min比61(45,75)min,P<0.001]和首次医疗接触至球囊扩张时间[83(62,117)min比96(70,127)min,P=0.032]均明显少于对照组,差异均有统计学意义;研究组患者发病至首次医疗接触时间虽大于对照组[101(38,188)min比85(53,186)min,P=0.920],但差异无统计学意义;与对照组相比,研究组患者院内主要不良心脑血管事件发生率更低(16.9%比27.3%,P=0.037),差异有统计学意义。多因素回归分析显示,Kilip心功能分级Ⅲ~Ⅳ级(OR 9.754,95%CI 3.548~26.813,P<0.001)及入门至球囊扩张时间>60 min(OR 1.816,95%CI 1.052~3.135,P=0.032)是发生院内主要不良心脑血管事件的独立危险因素。结论通过认证后胸痛中心持续规范化建设可进一步缩短急性心肌梗死救治时间,尤其是将入门至球囊扩张时间缩短到60 min之内,可降低患者院内不良事件发生率。
Objective To investigate the impact of chest pain center establishment on treatment time and in-hospital adverse events in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods Between September 2016 to December 2017, a total of 275 patients undergoing primary percutaneous coronary intervention were included. We compared door-to-balloon time, first medical contact-to-balloon time, symptom onset to first medical contact time and in-hospital MACCE between patients who were admitted before the chest pain center accreditation （control group, n=121） and after the center accreditation （study group, n=154）. The impact factors for in-hospital MACCE were studied by logistic regression analysis. Results Door-to-balloon time and first medical contact-toballoon time in study group were shorter than the control group [51 （34, 65） min vs. 61 （45, 75） min, P 〈 0.001 and 83（62,117） min vs. 96（70,127） min, P=0.032] respectively. Symptom onset to first medical contact time was longer in the study group （P 〉 0.05）. After repression analysis, Killip class Ⅲ - Ⅳ （OR 9.754, 95% CI 3.548-26.813, P 〈 0.001） and door-to-balloon time 〉 60 min （OR 1.816, 95% CI 1.052-3.135, P=0.032） were independently associated with in-hospital MACCE. Conclusions The progressive establishment of chest pain center after accreditation could further reduce treatment time delay, and reduce in-hospital MACCE especially by reduction of door-to-balloon time within 60 min.
作者
刘璇
李树仁
杨国慧
郑梅
郝潇
肖洒
LIU Xuan;LI Shu-ren;YANG Guo-hui;ZHENG Mei;HAO Xiao;XIAO Sa(Hebei Medical University,Shijiazhuang 050017,China)
出处
《中国介入心脏病学杂志》
2018年第11期622-626,共5页
Chinese Journal of Interventional Cardiology
关键词
胸痛中心
ST段抬高型心肌梗死
经皮冠状动脉介入治疗
Chest pain center
ST-segment elevation myocardial infarction
Percutaneous coronary intervention
