摘要
目的探讨胸痛救治快速反应体系对急性ST段抬高型心肌梗死(STEMI)患者救治近期和远期预后的影响。方法参照中国胸痛中心的要求建立胸痛中心并建立胸痛救治快速反应体系和救治流程。选取广西壮族自治区人民医院2014年6月至2015年11月收治的STEMI患者为观察组,选取未建立胸痛救治快速反应体系之前2012年1-12月收治的STEMI患者为对照组,共入选患者624例,观察组374例,对照组250例。采用回顾性非同期队列研究方法,观察组入院后采取胸痛救治快速反应体系进行救治,对照组在胸痛中心成立前入院进行常规救治。观察两组患者的一般情况、入院后首份心电图完成时间、入门球囊扩张时间(D2B)、住院时间、平均住院费用、住院期间不良心脏事件(院内病死、心力衰竭)发生率;所有出院患者随访1年,分别比较左室射血分数(LVEF)、左室舒张末内径(LVEDD)、室壁瘤形成、B型钠尿肽前体(pro-BNP)、血肌酐(Scr)、C反应蛋白(CRP)及不良心脏事件(心力衰竭、死亡、再次入院)发生率等。结果与对照组相比,观察组入院后首份心电图平均完成时间缩短(P=0.001),入门球囊扩张时间、住院时间、平均住院费用少于对照组(P<0.05),住院期间不良心脏事件(院内病死、心力衰竭)观察组低于对照组(P<0.05)。随访6个月后,观察组LVEF显著高于对照组(P<0.05),而观察组LVEDD、pro-BNP、CRP、不良心脏事件发生率均低于对照组(P<0.05),室壁瘤形成率和Scr水平在观察组与对照组之间差异无统计学意义(P>0.05)。随访1年后,观察组LVEF仍高于对照组(P<0.05),观察组LVEDD、pro-BNP、CREA、CRP、室壁瘤形成率、不良心脏事件发生率均低于对照组(P<0.05)。结论胸痛救治快速反应体系建立不仅有效缩短了STEMI患者的救治时间,提高了治疗效率,缩短住院时间,减少住院费用,还能改善生活质量和疾病预后。
Objective To investigate the effects of rapid response system of chest pain on the short-term and long-term prognosis of patients with acute ST segment elevation myocardial infarction （STEMI）. Methods Referring to the international association of chest pain centers, the chest pain center was established in this hospital, and the corresponding management system and treatment process were worked out. A total of 374 acute STEMI patients Who were recruited as the observation group were admitted to this hospital after the establishment of the chest pain center （December 2014 to June 2016） ,and 250 STEMI patients admitted before the establishment of the chest pain center （January 2012 to December 2012） were recruited as control group. Patients in observation group were treated in the chest pain center,and those in control group received conventional treatment. The general situation,basic diseases,the finishing time of the first electrocardiogram（ECG）,the time of door-to balloon expansion（D2B）,the time of hospital stay,the average hospitalization expenses,in-hospital cardiac events and in-6-month cardiac events were compared between the two groups. All patients were followed up for 1 years,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter （LVEDD）, left ventrieular aneurysm, B type natriuretic peptide （pro-BNP）, serum creatinine （Scr）, C-reactive protein （CRP）levels and adverse cardiac events （heart failure, death, readmission rate etc. ）were compared between two groups. Results Compared with the control group, the average completion time of the first electrocardiogram in the observation group was shortened （P= 0. 001）, the time of entry balloon dilatation, the time of hospital stay, the average hospitalization expenses were less than that of the control group （P〈0.05） ,the adverse cardiac events （hospital death and heart failure） were lower in the observation group than in the control group （P（0.05）. After 6 months of follow-up,LVEF was significantly higher in the observation group than in the control group （P〈0.05）. the levels of LVEDD, pro-BNP,CRP and adverse cardiac events in the observation group were significantly lower than those in the control group （P〈0.05）, there was no significant difference in the formation rate of ventricular aneurysm and Ser between the observation group and the control group （P〉0.05）. After 1 year of follow-up, LVEF was still higher in the observation group than in the control group （P〈0.05）. The incidence of LVEDD, pro-BNP,CREA,CRP,left ventricular aneurysm formation rate, the incidence of adverse cardiac events were lower in the observation group than in the control group （P〈0.05）.Conclusion The establishment of rapid response system of chest pain treatment not only effectively shorten the treatment time of STEMI patients,improve the treatment efficiency, shorten the hospital stay, reduce the cost of hospitalization, but also improve the quality of life and disease prognosis.
出处
《重庆医学》
CAS
北大核心
2017年第34期4790-4793,共4页
Chongqing medicine
基金
广西壮族自治区重大科技攻关科题(桂科攻14124003-9)
广西壮族自治区卫生厅自筹课题(Z2014213)
关键词
胸痛救治快速反应体系
胸痛中心
心肌梗死
预后
chest pain rapid response system
chest pain center
myocardial infarction
prognosis
作者简介
陆政德（1987-），住院医师，硕士，主要从事冠心病诊治的研究。;通信作者：E—mail：yingzhonglin@126．com。
