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胸痛中心建设对急性STEMI患者救治的影响

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目的 探讨胸痛中心建设对急性ST 段抬高型心肌梗死(STEMI)患者救治效率的影响。方法
连续入组2015年3月至2018年12月于酒泉市人民医院心内科STEMI患者542例,按入组时间接受治疗不同,
相应分为三组:导入期148例、干预期149例及胸痛中心运行期245例。比较三组患者来源,急救处置情况
(首份心电图时间、首次心电-签署知情时间、签署知情-穿剌时间,是否绕行急诊、CCU,门-球时间、
发病-球囊扩张时间、D2B达标率、使用药物);及治疗后情况(并发症、住院时间、院内及出院半年死
亡情况)。结果 三组患者来源有统计学差异,胸痛中心运行期外院转入患者明显较多(P<0.05)。三
组首份心电图时间、首次心电-签署知情时间、签署知情-穿剌时间,绕行CCU例数、绕行急诊和CCU例
数,D2B时间、D2B达标率、发病-球囊扩张时间,入院24 h内阿司匹林、波立维和肝素使用占比,院内β
受体阻滞剂、他汀类药物和ACEI/ARB占比、出院半年死亡例数均有统计学差异(P均<0.05)。其中,胸
痛中心运行期首份心电图时间、首次心电-签署知情时间、签署知情-穿剌时间,绕行CCU例数、绕行急
诊和CCU例数,D2B时间、D2B达标率、发病-球囊扩张时间明显优于其它两组(P均<0.05)。其余指标
组间相近(P均>0.05)。结论 胸痛中心建设可有效提高急性STEMI患者救治效率。

Abstract:

Objective To investigate the effect of the establishment of chest pain center on the treatment
efficiency of patients with acute ST segment elevation myocardial infarction (STEMI). Methods 542 consecutive
patients with STEMI from the Department of Cardiology, Jiuquan People's Hospital from March 2015 to December
2018 were enrolled. They were divided into three groups according to the time of enrollment: 148 cases during the
introduction period, 149 cases during the expected period, and 245 cases during the operation period. The sources
of patients , the emergency treatments (time of first electrocardiogram, time from first electrocardiogram to signing
informed consent, time from signing informed consent to punching, whether bypass emergency or CUU, D2B time,
time from incidence to balloon dilation, the compliance rate of D2B and drug use), and post-treatment conditions
(complications, length of stay, the death in-hospital and half a year after discharge) were compared. Results There
were significant differences in terms of sources of patients among groups, and the ratio of referral patients in chest pain
center operation period was higher than the other two groups (P<0.05). There were significant differences of time of first
electrocardiogram, time from first electrocardiogram to signing informed consent, time from signing informed consent
to punching, bypass emergency, bypass emergency and CUU, D2B time, time from incidence to balloon dilation, the
compliance rate of D2B, the use ratio of aspirin, Plavix and heparin in 24h, β-blocker, statin and ACEI/ARB in
hospital, the death half a year after discharge among three groups (P<0.05). And the time of first electrocardiogram,
time from first electrocardiogram to signing informed consent, time from signing informed consent to punching, bypass
emergency, bypass emergency and CUU, D2B time, time from incidence to balloon dilation in chest pain center
running period was better than the other two groups (P<0.05). The rest indexes were similar (P>0.05). Conclusion The
construction of chest pain center could improve the treatment effect of patients with STEMI.

基金项目:

2014年甘肃省卫生行业科研计划管理项目(GWGL2014-86)

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