摘要
目的探讨不同来院方式对急性ST段抬高型心肌梗死(STEMI)患者的再灌注时间及短期预后的影响。方法纳入2023年1月至2024年11月在厦门大学附属心血管病医院胸痛中心就诊并被诊断为STEMI的患者497例,所有患者均接受直接经皮冠状动脉介入治疗。根据来院方式不同将患者分为自行来院组(122例)、“120”转运组(51例)和网络医院转诊组(324例)。比较3组患者的基本特征、再灌注时间和住院期间并发症。结果497例STEMI患者年龄(58.64±13.62)岁,男423例(85.11%)。与自行来院组、“120”转运组相比,网络医院转诊组的入门至导丝通过时间更短[35(29,45)min比43(35,53)min比43(33,48)min,P<0.001],但首次医疗接触至导丝通过时间更长[123(80,192)min比43(35,52)min比57(51,76)min,P<0.001],差异均有统计学意义。与自行来院组、网络医院转诊组相比,“120”转运组的发病至首次医疗接触时间[55(32,136)min比185(116,360)min比120(60,236)min,P<0.001]和发病至导丝通过时间[136(101,188)min比228(169,413)min比282(190,400)min,P<0.001]更短,差异均有统计学意义。网络医院转诊组的院内感染发生率低于自行来院组(12.65%比22.95%,P<0.05)。结论为全面提升救治效果,应优先推广并持续优化“120”响应流程,同步强化网络医院转诊标准化协作,并通过公众宣教增强STEMI识别能力,减少自行来院延误。
Objective To explore the impact of admission modes on the reperfusion time and short-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods 497 patients who visited the Chest Pain Center of Xiamen Cardiovascular Hospital of Xiamen University from January 2023 to November 2024 and were diagnosed with STEMI were included.All patients received direct percutaneous coronary intervention.According to admission modes,the patients were divided into the self-referral group(122 cases),emergency medical service group(EMS)(51 cases)and transfer PCI group(324 cases).The basic characteristics,reperfusion time,complications between group were compared.Results The age of the patients in this study was(58.64±13.62)years old,and there were 423 male cases(85.11%).Compared with the self-referral group and the EMS group,the time of door-wire in transfer PCI group was shorter[35(29,45)min vs.43(35,53)min vs.43(33,48)min,P<0.001],but the time of first medical contact-wire was longer[123(80,192)min vs.43(35,52)min vs.57(51,76)min,P<0.001].Compared with the self-referral group and the transfer PCI group,the time of symptom-to-first medical contact and the time of symptom-to-wire in EMS group were both shorter,which were[55(32,136)min vs.185(116,360)min vs.120(60,236)min,P<0.001]and[136(101,188)min vs.228(169,413)min vs.282(190,400)min,P<0.001].The incidence of infections in the transfer PCI group was lower than that in the self-referral group(12.65%vs.22.95%,P<0.05).Conclusions To comprehensively enhance the treatment effect,it is necessary to prioritize the promotion and continuous optimization of the response process of EMS,simultaneously strengthen the standardized collaboration of referral,and enhance the identification ability of STEMI through public education to reduce the delay of self-referral patients..
作者
林吉怡
欧尾妹
黄薇薇
王焱
林绍清
陈媛
王斌
LIN Ji-yi;OU Wei-mei;HUANG Wei-wei;WANG Yan;LIN Shao-qing;CHEN Yuan;WANG Bin(Emergency Department,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361000,China;Xiamen Chest Pain Quality Control Center,Xiamen 361000,China;Operation Management Department,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361000,China;Department of Cardiology,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361000,China)
出处
《中国介入心脏病学杂志》
2025年第8期447-453,共7页
Chinese Journal of Interventional Cardiology
基金
厦门市科技计划项目(3502Z20224008)
厦门市自然科学基金项目(3502Z202371050)。
关键词
心肌梗死
来院方式
再灌注时间
短期预后
胸痛中心
Myocardial infarction
Admission modes
Reperfusion time
Short-term prognosis
Chest Pain Center
