基层胸痛中心建设对急性心肌梗死患者临床治疗效果及预后的影响
| 作者: |
1林海云,
1吴咏豪,
1李利群
1 莞市东部中心医院心内科，广东 东莞 523573 |
| 通讯: |
吴咏豪
Email: 373370250@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.02.017 |
| 基金: | 东莞市社会科技发展(一般)项目(2018507150351179)。 |
摘要
目的：探讨基层胸痛中心建设对急性心肌梗死(acute myocardial infarction，AMI)患者临床治疗效果及预后的影响。方法：东莞市东部中心医院于2017年3月开始运行胸痛中心，将运行前(2015年3月至2017年2月)实施传统临床路径的AMI患者116例纳入实施前，将运行后(2017年3月至2019年3月)给予基层胸痛中心绿色通道救治的AMI患者121例纳入实施后，比较实施前后两组患者胸痛缓解和血管再通情况、首次医疗接触(first medical contact，FMC)至心电图时间、心电图确诊时间、FMC-球囊扩张(FMC-to-balloon，FMC2B)时间、就诊-球囊扩张(door-to-balloon，D2B)时间、总缺血时间、24 h内相关药物使用率、院内临床事件发生率。结果：实施前后两组患者胸痛缓解、血管再通比例比较差异无统计学意义(P>0.05)；实施后AMI患者FMC至心电图时间、心电图确诊时间、FMC2B时间、D2B时间、总缺血时间均短于实施前患者(P<0.05)；实施前后两组患者β受体阻滞剂、ACEI/ARB、他汀类药物使用率比较差异无统计学意义(P>0.05)；实施前后两组患者发生院内死亡、靶血管重建、Killip心功能II级以上比例比较差异无统计学意义(P>0.05)；实施后AMI患者主要不良心血管事件(main adverse cardiac events，MACE；包括室颤、心脏骤停、心力衰竭、室性心动过速)总发生率5.79%，低于实施前的13.79%(P<0.05)。结论：基层医院胸痛中心的建立可提高AMI患者救治效率，缩短患者心肌缺血时间，降低住院期间MACE发生率，改善患者预后。
关键词：
基层医院；胸痛中心建设；急性心肌梗死；临床治疗效果；预后
Influences of the construction of primary chest pain centers on clinical curative effect and prognosis of patients with acute myocardial infarction
CorrespondingAuthor: WU Yonghao Email: 373370250@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.02.017
Foundation: This work was supported by Dongguan Social Science and Technology Development (General), China (2018507150351179).
Abstract
Objective: To explore the influences of the construction of primary chest pain centers on clinical curative effect and prognosis of patients with acute myocardial infarction (AMI). Methods: The chest pain center has been in service in Dongguan East Central Hospital since March 2017. The 116 AMI patients who were given traditional clinical pathway before the implementation (March 2015 to February 2017) were included in the pre-implementation group, while another 121 AMI patients who were given green channel treatment in primary chest pain center (March 2017 to March 2019) were included in the post-implementation group. The chest pain relief and vascular recanalization before and after implementation, interval from the first medical contact (FMC) to ECG, confirmed time by ECG, interval from FMC-to-balloon (FMC2B), interval from Door-to-Balloon (D2B), total ischemic time, usage rate of related drugs within 24 h, and incidence of nosocomial clinical events were compared between the two groups. Results: There was no significant difference in the proportion of chest pain relief and vascular recanalization before and after implementation (P>0.05). After implementation, interval from FMC to ECG, confirmed time by ECG, interval from FMC2B, interval from D2B and total ischemic time were shortened (P<0.05). Before and after implementation, there was no significant difference in usage rate of β-blocker, ACEI/ARB, and statin between the two groups (P>0.05). Before and after implementation, there was no significant difference in proportion of nosocomial death, target vessel reconstruction and Killip cardiac function grading at above grade II between the two groups (P>0.05). The total incidence of MACE (ventricular fibrillation, cardiac arrest, heart failure, ventricular tachycardia) after implementation was lower than that before implementation (5.79% vs 13.79%) (P<0.05). Conclusion: The construction of chest pain centers in primary hospitals can greatly improve rescue efficiency of AMI patients, shorten myocardial ischemia time, reduce the incidence of MACE during hospitalization, and improve their prognoses.
Keywords：
primary hospital; construction of chest pain center; acute myocardial infarction; clinical curative effect; prognosis