摘要
目的探讨在胸痛中心(CPC)模式下诊疗过程再优化对ST抬高型心肌梗死(STEMI)患者诊治时间及临床疗效的影响。方法回顾分析2019年1月—2020年12月在徐州医科大学附属淮安医院胸痛中心就诊并行直接经皮冠状动脉介入(PCI)治疗的STEMI患者117例。将2019年1月—2019年12月的54例作为对照组,2020年1月—2020年12月的63例作为观察组,比较两组患者一般临床资料、各诊治时间点、临床疗效和其他指标。结果两组患者一般临床资料比较,差异无统计学意义(P>0.05)。观察组患者各诊治时间点优于对照组,两组相比差异均具有统计学意义(P<0.05)。经治疗:观察组患者左心室射血分数(LVEF)及6 min步行距离(6MWD)优于对照组,观察组患者术后Killip分级明显优于对照组,观察组术后总严重并发症、室上性心动过速以及住院时间均明显低于对照组,差异均有统计学意义(P<0.05)。而室性心动过速、心室颤动、严重心衰、心源性休克、重度房室阻滞以及住院期间死亡率比较,两组患者差异无统计学意义(P>0.05)。观察组患者STEMI心电图漏诊率(0)低于对照组(11.11%),院外心电图传输率(90.0%)高于对照组(33.33%),差异均具有统计学意义(P<0.05)。结论针对胸痛中心模式的诊疗过程再优化,可进一步降低患者关键诊疗时间,尤其缩短患方同意PCI术时间及门-球时间(D to B),进而挽救更多濒死心肌,减少患者心功能受损,减少术后总并发症和住院时间,但对住院期间死亡率无明显影响。
Objective To investigate the impact of reoptimization of the diagnosis and treatment process in the chest pain center(CPC)mode on the diagnosis and treatment time and clinical efficacy of ST-segment elevated myocardial infarction(STEMI)patients.Methods A retrospective analysis of 117 STEMI patients who attended the chest pain center of our hospital from January 2019 to December 2020 and received primary percutaneous coronary intervention(PPCI).54 cases from January 2019 to December 2019 were used as the control group,and 63 cases from January 2020 to December 2020 were used as the observation group.The general clinical data,time points of diagnosis and treatment,clinical efficacy and others of the two groups were compared.Results There was no significant difference in general clinical data between the two groups of patients(P>0.05).The diagnosis and treatment time points of the observation group were better than those of the control group,and the difference between the two groups was statistically significant(P<0.05).After treatment:LVEF and 6MWD of the observation group were also better than those of the control group,and the Killip classification of patients in the observation group was significantly better than that in the control group,and the differences between the two groups were statistically significant(P<0.05).The total postoperative severe complications,supraventricular tachycardia,and length of stay in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups of patients with ventricular tachycardia,ventricular fibrillation,severe heart failure,cardiogenic shock,severe atrioventricular block,and mortality during hospitalization(P>0.05).The STEMI ECG missed diagnosis rate(0)of the observation group was lower than 11.11%in the control group,and the out-of-hospital ECG transmission rate(90.0%)was higher than 33.33%in the control group,the differences were statistically significant(P<0.05).Conclusion Reoptimization of the diagnosis and treatment process for chest pain center mode can further reduce the critical diagnosis and treatment time of patients,especially shorten the time for patients to agree to PCI and D to B time,thereby saving more dying myocardium and reducing patients′heart function Damage,reducing the total postoperative complications and hospital stay,but has no significant effect on the mortality rate during hospitalization.
作者
胡晓曼
许艳
沈霖
HU Xiaoman;XU Yan;SHEN Lin(Emergency Department,the Affiliated Huai′an Hospital of Xuzhou Medical University(Second People′s Hospital),Huai′an Jiangsu 223002,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第9期1130-1134,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
ST抬高型心肌梗死
胸痛中心
过程优化
门-球时间
临床疗效
ST elevation myocardial infarction
Chest pain center
Process optimization
Goal-ball time
Clinical efficacy
作者简介
通信作者:沈霖,E-mail:shenlin81@163.com。
