| 于春强,印建荣,王士凯,朱其行,徐通达.绕行急诊和直接呼叫120对基层医院胸痛中心急性ST段抬高型心肌梗死患者PCI救治的影响[J].,2019,19(20):3977-3981 |
| 绕行急诊和直接呼叫120对基层医院胸痛中心急性ST段抬高型心肌梗死患者PCI救治的影响 |
| Effect of Bypassing Emergency and Directly Calling 120 on Patients with Acute ST-segment Elevation Myocardial Infarction in Chest Pain Center of Primary Hospital |
| 投稿时间：2019-03-06 修订日期：2019-03-31 |
| DOI：10.13241/j.cnki.pmb.2019.20.040 |
| 中文关键词: 心肌梗死 绕行急诊 基层医院 胸痛中心 经皮冠状动脉介入治疗 |
| 英文关键词: Myocardial infarction Bypass emergency Primary hospital Chest pain center Percutaneous coronary intervention |
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| 中文摘要: |
| 摘要 目的：探讨绕行急诊、直接呼叫120能否缩短基层医院胸痛中心急性ST段抬高型心肌梗死患者急诊PCI的再灌注时间及改善短期预后。方法：回顾性分析自2016年11月至2018年12月邳州市人民医院胸痛中心连续收治的行急诊PCI治疗并符合入组标准的STEMI患者共405例，分为绕行急诊组198例（包括直接呼叫120转运组95例和网络医院转诊组105例）和非绕行急诊组207例，对比分析两组之间一般资料；PCI相关情况；救治质量指标：1.基线及24小时CKMB、cTnI、 BNP、 hs-CRP、PCT，2.术后30 min及发病24小时ST段回落率，3.术后1周心脏超声LVEF、LVDd，4.术后1周心率变异性时域指标SDNN，5.住院期间MACE事件及总MACE事件发生率，6.住院期间出血并发症，7.住院天数；救治时间指标：S2B时间、S2FMC时间、FMC2ECG时间、FMC2DAPT时间、FMC2B时间、FMC2B达标率、D2B时间、D2B达标率，并进一步对绕行急诊组进行亚组分析，对比分析直接呼叫120组及网络医院转诊组的相关指标。结果：1.绕行急诊组与非绕行急诊组相比，mini-GRACE评分较低，术中再灌注心律失常比例较高，24小时CKMB、 cTnI、BNP、hs-CRP、PCT较低，术后30 min及24小时ST段回落率较高，术后1周LVEF较高、LVDd较小，术后1周SDNN较高，住院期间心力衰竭及总MACE事件发生率较低，S2B时间、FMC2ECG时间、FMC2DAPT时间、FMC2B时间、D2B时间较短，FMC2B达标率、D2B达标率高，具有统计学意义（P＜0.05）。 2.直接呼叫120组与网络医院转诊组相比，24小时CKMB、 cTnI、BNP、hs-CRP、PCT较低，术后1周LVEF较高、LVDd较小，术后1周SDNN较高，住院期间心力衰竭及总MACE事件发生率较低，S2B时间、FM2B时间较短，FMC2B达标率较高，具有统计学意义（P＜0.05）。结论：绕行急诊和直接呼叫120能缩短基层医院胸痛中心STEMI患者急诊PCI的救治时间，并能改善预后，对本地区及其他基层医院STEMI救治的规范化建设具有一定参考意义。 |
| 英文摘要: |
| ABSTRACT Objective: To explore whether bypassing emergency and directly calling 120 can shorten the reperfusion time of emergency PCI and improve short-term prognosis in patients with acute ST-segment elevation myocardial infarction in primary hospital chest pain center. Methods: Retrospectively analysis 405 consecutive patients with STEMI who underwent emergency PCI treatment from November 2016 to December 2018 in the Chest Pain Center of Pi Zhou People's Hospital and who met the inclusion criteria, and divided them into bypassing emergency group with 198 cases (including directly calling group with 95 cases and network-hospital referral group with 103 cases) and the non-bypassing emergency group with 207 cases. The general data and PCI-related conditions between the two groups were compared. Quality indicators of treatment: 1. baseline and 24-hour CKMB, cTnI, BNP, hs-CRP, PCT；2. ST-segment regression rate 30 min after surgery and 24-hour onset, 3. LVEF and LVDd in heart ultrasound 1 week after surgery, 4. Heart rate variability time domain indicator SDNN 1 week after surgery, 5. The incidence of MACE events and total MACE events during hospitalization, 6. bleeding complications during hospitalization, 7. hospitalization days; treatment time indicators: S2B time, S2FMC time, FMC2ECG time, FMC2DAPT time, FMC2B time, FMC2B compliance rate, D2B time, D2B compliance rate. We further conducted a subgroup analysis of the bypass emergency group, and compared the relevant indicators of the directly-calling-120 group and the network hospital referral group. Results: 1. Compared with the non- bypassing emergency group, the bypassing emergency group's mini-GRACE score was lower, the intraoperative reperfusion arrhythmia ratio was higher, and 24 hours CKMB, cTnI, BNP, hs-CRP, PCT were lower, and the ST-segment regression rate 30 min and 24-hour after surgery was higher, the LVEF was higher and the LVDd was smaller at 1 week after surgery, the SDNN was higher 1 week after surgery, the incidence of heart failure and total MACE events during hospitalization was lower, and S2B time, FMC2ECG time, FMC2DAPT time, FMC2B time, D2B time were shorter, FMC2B compliance rate and D2B compliance rate were higher, all of the difference were statistically significant (P<0.05). 2. Compared with the network-hospital referral group, the directly-calling-120 group's CKMB, cTnI, BNP, hs-CRP and PCT were lower after 24 hours, LVEF and SDNN 1 were higher, LVDd was less 1 week after surgery, the incidence of heart failure and total MACE events during hospitalization was lower, S2B time and FM2B time were shorter, and FMC2B compliance rate was higher, all of the difference were statistically significant (P<0.05). Conclusion: Bypassing emergency group and directly-calling-120 can shorten the emergency treatment time of STEMI patients in the chest pain center of the primary hospital, and can improve the prognosis. It has certain reference significance for the standardized construction of STEMI treatment in the local and other primary hospitals. |
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