摘要
目的:探讨胸痛中心流程优化对急性心肌梗死(AMI)患者急救时间及急救效果的影响。方法:本病例对照研究回顾性纳入2022年5月-2023年5月于首都医科大学附属北京朝阳医院急诊胸痛中心流程优化前收治的80例ST段抬高型急性心肌梗死(STEMI)患者为优化前组,并选择2023年6月-2024年12月于首都医科大学附属北京朝阳医院急诊胸痛中心流程优化后收治的80例STEMI患者为优化后组,比较两组急诊各环节用时、救治达标率、心肌肌钙蛋白I(cTnI)水平、住院时间、住院费用、院内死亡率、3个月内死亡率、主要不良心血管事件(MACE)发生率。结果:优化前组和优化后组在平均年龄[(62.9±9.1)岁比(63.0±8.7)岁],男性比例(68.8%比61.3%)方面差异无统计学意义(P均>0.05)。与优化前组比较,优化后组急诊停留时间[(39.85±8.22)min比(66.52±14.52)min]、登记挂号时间[(2.87±2.15)min比(10.47±3.23)min]、心电图时间[(3.12±1.05)min比(8.28±2.41)min]、导管室激活时间[(3.41±1.22)min比(9.33±2.16)min]、肌钙蛋白报告时间[(22.72±4.93)min比(27.41±5.68)min]显著降低(P均<0.001),首次医疗接触-球囊扩张时间达标率(93.8%比83.8%)、门-球时间达标率(95.0%比83.8%)、首次医疗接触-首份心电图时间达标率(96.3%比87.5%)显著升高(P均<0.05);术后24 h的cTnI水平[(0.69±0.14)μg/L比(0.78±0.15)μg/L],术后72 h的cTnI水平[(0.26±0.05)μg/L比(0.37±0.09)μg/L]显著降低(P均<0.001)。两组院内死亡率、3个月内死亡率及MACE发生率无显著差异(P均>0.05)。结论:胸痛中心流程优化可缩短AMI患者急诊各环节时间,改善cTnI水平,提高救治达标率。
Objective:To investigate the effects of chest pain center process optimization on the time and outcome of first-aid in patients with acute myocardial infarction(AMI).Methods:This case-control study retrospectively enrolled 80 patients with ST-segment elevation acute myocardial infarction(STEMI)admitted to the Emergency Chest Pain Center of Beijing Chao-yang Hospital,Capital Medical University before process optimization between May 2022 and May 2023 as pre-optimization group,and 80 patients with STEMI admitted to the Emergency Chest Pain Center of Beijing Chao-yang Hospital,Capital Medical University after process optimization between June 2023 and December 2024 as the post-optimization group.Time consumption of each emergency procedure,rescue compliance rate,cardiac troponin I(cTnI)level,in-hospital stay,hospitalization cost,in-hospital mortality,mortality within 3-month,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results:There was no significant difference in the mean age[(62.9±9.1)years vs.(63.0±8.7)years]and the proportion of male(68.8%vs.61.3%)between the two groups(P>0.05 both).Compared to those in the pre-optimization group,patients in the post-optimization group had significantly shorter emergency stay time[(39.85±8.22)min vs.(66.52±14.52)min],registration time[(2.87±2.15)min vs.(10.47±3.23)min],ECG time[(3.12±1.05)min vs.(8.28±2.41)min],catheterization room activation time[(3.41±1.22)min vs.(9.33±2.16)min]and troponin report time[(22.72±4.93)min vs.(27.41±5.68)min](P<0.001 all),and significantly higher first medical contact-balloon dilatation time compliance rate(93.8%vs.83.8%),door-to-balloon time compliance rate(95.0%vs.83.8%),and the first medical contact-first ECG time compliance rate(96.3%vs.87.5%,P<0.05 all).Compared to those in the pre-optimization group,patients in the post-optimization group had significantly lower serum cTnI level[24h:(0.69±0.14)μg/L vs.(0.78±0.15)μg/L,72h:(0.26±0.05)μg/L vs.(0.37±0.09)μg/L]after operation(P<0.001 all).We detect no significant difference in in-hospital mortality,mortality within 3-month and incidence of MACE between two groups(P>0.05 all).Conclusion:Chest pain center process optimization may shorten the time of each emergency procedure,improve cTnI level and rescue compliance rate in patients with AMI.
作者
陈霏
绳莲松
吴娜
CHEN Fei;SHENG Lian-song;WU Na(Emergency Department,Beijing Chao-yang Hospital,Capital Medical University,Beijing,100000,China)
出处
《心血管康复医学杂志》
2026年第1期127-133,共7页
Chinese Journal of Cardiovascular Rehabilitation Medicine
关键词
心肌梗死
急救医疗服务
肌钙蛋白I
Myocardial infarction
Emergency medical services
Troponin I
