CAJ | 학술논문

目的：探讨胸痛中心（CPC）对不同来院方式接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高急性心肌梗死（STEMI）患者进门-球囊（D-to-B）时间的影响。方法根据来院方式不同将CPC成立前、后接受PPCI的STEMI患者分别分为自行来院组[A1组（52例）和A2组（65例）]、呼叫“120”组[B1组（31例）和B2组（92例）]、非经皮冠状动脉介入治疗（PCI）医院转诊组[C1组（23例）和C2组（552例）]，比较同一来院方式的两组间D-to-B时间和D-to-B达标率的变化，分析延迟原因。结果 A1、A2组平均D-to-B时间分别是（123±78）min和（140±123）min，达标率分别为44.2%和46.2%，两组间比较，差异均无统计学意义（P＞0.05）；B2组平均D-to-B时间显著短于B1组[（89±66）min比（155±115）min，P＜0.05]，而达标率显著高于B1组（69.6%比32.3%，P＜0.05）；C2组平均D-to-B时间显著短于C1组[（77±43）min比（337±662）min， P＜0.05]，达标率显著高于C1组（75.7%比21.7%，P＜0.05）。自行来院组的主要延迟原因是签署知情同意书时间过长，呼叫“120”组和非PCI医院转诊组的主要延迟原因是导管室占台。结论区域协同救治模式CPC显著缩短了呼叫“120”和转诊入院患者的D-to-B时间，但需加强对自行来院途径的院内流程优化。
목적：탐토흉통중심（CPC）대불동래원방식접수직접경피관상동맥개입치료（PPCI）적ST단태고급성심기경사（STEMI）환자진문-구낭（D-to-B）시간적영향。방법근거래원방식불동장CPC성립전、후접수PPCI적STEMI환자분별분위자행래원조[A1조（52례）화A2조（65례）]、호규“120”조[B1조（31례）화B2조（92례）]、비경피관상동맥개입치료（PCI）의원전진조[C1조（23례）화C2조（552례）]，비교동일래원방식적량조간D-to-B시간화D-to-B체표솔적변화，분석연지원인。결과 A1、A2조평균D-to-B시간분별시（123±78）min화（140±123）min，체표솔분별위44.2%화46.2%，량조간비교，차이균무통계학의의（P＞0.05）；B2조평균D-to-B시간현저단우B1조[（89±66）min비（155±115）min，P＜0.05]，이체표솔현저고우B1조（69.6%비32.3%，P＜0.05）；C2조평균D-to-B시간현저단우C1조[（77±43）min비（337±662）min， P＜0.05]，체표솔현저고우C1조（75.7%비21.7%，P＜0.05）。자행래원조적주요연지원인시첨서지정동의서시간과장，호규“120”조화비PCI의원전진조적주요연지원인시도관실점태。결론구역협동구치모식CPC현저축단료호규“120”화전진입원환자적D-to-B시간，단수가강대자행래원도경적원내류정우화。
Objective This study intends to explore the impacts of the establishment of chest pain center(CPC) on the door-to-balloon(D-to-B) time in patients with ST-elevation myocardial infarction (STEMI) by different transfer ways to hospital. Methods A regular CPC and a regional cooperative network were established based on the pre-hospital transmitted real-time 12-lead electrocardiogram system. The STEMI patients were divided into the following three groups by the different transfer ways to hospital before and after the establishment of chest pain center:self-referral groups (group A1, n=52, and group A2, n=65), EMS (emergency medical service ) groups (group B1, n=31, and group B2, n=92) and transfer PCI groups (group C1, n=23, and group C2, n=552). The mean D-to-B time and the rate of D-to-B below 90 minutes were compared between before and after the establishment of CPC and the reasons of reperfusion delay were analyzed. Results There were no statistical differences of the average D-to-B time [(123±78) min vs.(140±123)min, P > 0.05] and the rate of D-to-B time below 90 min (44.2%vs. 46.2%) between group A1 and group A2. The average D-to-B time was significantly shortened in group B2 [(89±66)min] while compared with that in group B1 [(155±115)min, P<0.05] and the rate of D-to-B time below 90 min was remarkably elevated in group B2 compared with that of group B1 (69.6%vs. 32.3%, P<0.05). The average D-to-B time was significant shorter in group C2 than in group C1 [(77±43)min vs. (337±662)min, P<0.05] and the rate of D-to-B time below 90 min was remarkable higher in group C2 than in group C1 (75.7%vs. 21.7%, P<0.05). The longer D-to-B time in self-referral groups was mainly due to the delay of getting informed consent before PCI when occupied catheterization laboratory was the major cause of reperfusion delay in EMS groups and transfer PCI groups. Conclusions The establishment of CPC may significantly shorten the D-to-B time and increase the rate of D-to-B time below 90 min for these patients admitted by EMS and transferred from non-PCI hospitals. However, the pathway for the self-referral patients should be further modified.