中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
7期
568-571
,共4页
向定成%段天兵%秦伟毅%罗望胜%张金霞%易绍东%阮云军%肖华
嚮定成%段天兵%秦偉毅%囉望勝%張金霞%易紹東%阮雲軍%肖華
향정성%단천병%진위의%라망성%장금하%역소동%원운군%초화
心肌梗死%血管成形术,经腔,经皮冠状动脉%医师诊疗模式
心肌梗死%血管成形術,經腔,經皮冠狀動脈%醫師診療模式
심기경사%혈관성형술,경강,경피관상동맥%의사진료모식
Myocardial infarction%Angioplasty,transluminal,percutaneous coronary%Physician's practice patterns
目的 探讨规范化胸痛中心模式对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)的进门至球囊扩张(D-to-B)时间和预后的影响.方法 通过院前传输12导联心电图作为院前诊断STEMI的技术手段建立规范化胸痛中心,使PPCI患者实现绕行急诊室方案直达导管室.以胸痛中心建立前1年接受PPCI的STEMI患者作为A组(93例),胸痛中心建立后1年接受PPCI的STEMI患者作为B组(149例),比较两组的D-to-B时间、住院病死率、心力衰竭发生率、住院时间和校正的人均住院费用.结果 B组年平均D-to-B时间显著短于A组[(72±23) min比(127±79) rain,P<0.01];最短月平均D-to-B时间亦显著短于A组[(56±11)min比(73±14)min,P<0.01];年D-to-B时间达标率A组和B组分别为62.4% (58/93)和91.9% (137/149) (P <0.05);住院病死率A组和B组分别为6.5% (6/93)和3.4%(5/149) (P>0.05);住院期间心力衰竭发生率A组和B组分别为24.7% (23/93)和14.1% (21/149) (P <0.05);住院时间A组和B组分别为(8.98±4.89)d和(7.79±5.43)d(P>0.05);B组校正的人均住院费用比A组低9.4%(P<0.05).结论 规范化胸痛中心模式可以显著缩短STEMI患者PPCI的D-to-B时间、改善预后并节省住院费用.
目的 探討規範化胸痛中心模式對急性ST段抬高型心肌梗死(STEMI)患者直接經皮冠狀動脈介入治療(PPCI)的進門至毬囊擴張(D-to-B)時間和預後的影響.方法 通過院前傳輸12導聯心電圖作為院前診斷STEMI的技術手段建立規範化胸痛中心,使PPCI患者實現繞行急診室方案直達導管室.以胸痛中心建立前1年接受PPCI的STEMI患者作為A組(93例),胸痛中心建立後1年接受PPCI的STEMI患者作為B組(149例),比較兩組的D-to-B時間、住院病死率、心力衰竭髮生率、住院時間和校正的人均住院費用.結果 B組年平均D-to-B時間顯著短于A組[(72±23) min比(127±79) rain,P<0.01];最短月平均D-to-B時間亦顯著短于A組[(56±11)min比(73±14)min,P<0.01];年D-to-B時間達標率A組和B組分彆為62.4% (58/93)和91.9% (137/149) (P <0.05);住院病死率A組和B組分彆為6.5% (6/93)和3.4%(5/149) (P>0.05);住院期間心力衰竭髮生率A組和B組分彆為24.7% (23/93)和14.1% (21/149) (P <0.05);住院時間A組和B組分彆為(8.98±4.89)d和(7.79±5.43)d(P>0.05);B組校正的人均住院費用比A組低9.4%(P<0.05).結論 規範化胸痛中心模式可以顯著縮短STEMI患者PPCI的D-to-B時間、改善預後併節省住院費用.
목적 탐토규범화흉통중심모식대급성ST단태고형심기경사(STEMI)환자직접경피관상동맥개입치료(PPCI)적진문지구낭확장(D-to-B)시간화예후적영향.방법 통과원전전수12도련심전도작위원전진단STEMI적기술수단건립규범화흉통중심,사PPCI환자실현요행급진실방안직체도관실.이흉통중심건립전1년접수PPCI적STEMI환자작위A조(93례),흉통중심건립후1년접수PPCI적STEMI환자작위B조(149례),비교량조적D-to-B시간、주원병사솔、심력쇠갈발생솔、주원시간화교정적인균주원비용.결과 B조년평균D-to-B시간현저단우A조[(72±23) min비(127±79) rain,P<0.01];최단월평균D-to-B시간역현저단우A조[(56±11)min비(73±14)min,P<0.01];년D-to-B시간체표솔A조화B조분별위62.4% (58/93)화91.9% (137/149) (P <0.05);주원병사솔A조화B조분별위6.5% (6/93)화3.4%(5/149) (P>0.05);주원기간심력쇠갈발생솔A조화B조분별위24.7% (23/93)화14.1% (21/149) (P <0.05);주원시간A조화B조분별위(8.98±4.89)d화(7.79±5.43)d(P>0.05);B조교정적인균주원비용비A조저9.4%(P<0.05).결론 규범화흉통중심모식가이현저축단STEMI환자PPCI적D-to-B시간、개선예후병절성주원비용.
Objective To investigate the impact of the establishment of chest pain center (CPC) model based on the pre-hospital real-time tele-12-1ead electrocardiogram on the door-to-balloon (D-to-B) time and short-term outcome after primary percutaneous coronary intervention (PPCI) of patients with ST-segment elevated myocardial infarction (STEMI).Methods A regular CPC was established with prehospital transmitted real-time 12-lead electrocardiogram system for pre-hospital diagnosis of STEMI and enabled the STEMI patients to bypass the emergency room and directly treated in the catheter lab to shorten the D-to-B time.The mean D-to-B time,the short-term outcome and medical costs were compared in PPCI patients before (93 cases,group A) and after (149 cases,group B) the establishment of CPC.Results After the establishment of CPC,the annual mean D-to-B time was significantly shortened [(127 ± 79) min in group A vs.(72 ± 23)min in group B,P < 0.01],the shortest monthly mean D-to-B time was remarkably reduced in group B than in group A [(56 ± 11) min vs.(73 ± 14) min,P < 0.01].The annual ratio of D-to-B below 90 minutes was significantly increased from 62.4% (58/93) in group A to 91.9% (137/149) in group B (P <0.05).The in-hospital mortality rate tended to be lower and the incidence of heart failure during hospitalization was significantly reduced in group B compared with group A [3.4% (5/149) vs.6.5% (6/93),P > 0.05 ; 14.1% (21/149) vs.24.7% (23/93),P < 0.05].The length of hospital stay was slightly shortened from (8.98 ± 4.89) days to (7.79 ± 5.43) days (P > 0.05).Corrected mean medical cost went down by 9.4% (P < 0.05).Conclusion The establishment of CPC may significantly shorten the D-to-B time,improve the short-term outcome and reduce the hospitalization cost for PPCI patients with STEMI.