CAJ | 학술논문

目的：探讨“急救车-导管室”模式对急性ST段抬高型心肌梗死（STEMI）患者入门-球囊扩张时间与左室功能的影响。方法选择2011年1月至2013年12月海军总医院心脏中心行急诊经皮冠状动脉介入（PCI）治疗并完成3个月随访的STEMI患者416例，按照患者进入导管室的模式分为“急救车-导管室”组和“急救车-急诊科-导管室”两组，记录两组患者靶血管病变、心功能Killip分级，比较两组患者开通血管时间、入院和PCI术后3个月左室射血分数（LVEF）及变化值。结果两组患者间基线情况、靶血管病变、心功能killip分级等无统计学差异（P＞0.05）；两组症状发作-医院就诊时间无统计学差异（P＞0.05），“急救车-导管室”组在平均入门-球囊扩张时间[（44.3±11.8）min vs.（82.9±12.6）min]和症状发作-开通血管时间[（511.8±219.9）min vs.（558.6±245.6）min]均低于对照组，且存在统计学差异（P＜0.05）。两组患者入院时LVEF相似，但在PCI术后3个月随访时，“急救车-导管室”组在LVEF及LVEF增加值均高于对照组（P＜0.05）。结论“急救车-导管室”模式可缩短STEMI患者急诊PCI入门-球囊扩张时间、症状发作-开通血管时间及改善术后3个月时左心室功能。
목적：탐토“급구차-도관실”모식대급성ST단태고형심기경사（STEMI）환자입문-구낭확장시간여좌실공능적영향。방법선택2011년1월지2013년12월해군총의원심장중심행급진경피관상동맥개입（PCI）치료병완성3개월수방적STEMI환자416례，안조환자진입도관실적모식분위“급구차-도관실”조화“급구차-급진과-도관실”량조，기록량조환자파혈관병변、심공능Killip분급，비교량조환자개통혈관시간、입원화PCI술후3개월좌실사혈분수（LVEF）급변화치。결과량조환자간기선정황、파혈관병변、심공능killip분급등무통계학차이（P＞0.05）；량조증상발작-의원취진시간무통계학차이（P＞0.05），“급구차-도관실”조재평균입문-구낭확장시간[（44.3±11.8）min vs.（82.9±12.6）min]화증상발작-개통혈관시간[（511.8±219.9）min vs.（558.6±245.6）min]균저우대조조，차존재통계학차이（P＜0.05）。량조환자입원시LVEF상사，단재PCI술후3개월수방시，“급구차-도관실”조재LVEF급LVEF증가치균고우대조조（P＜0.05）。결론“급구차-도관실”모식가축단STEMI환자급진PCI입문-구낭확장시간、증상발작-개통혈관시간급개선술후3개월시좌심실공능。
Objective To discuss the influences of mode of ambulance-catheter room on door-to-balloon time (DBT) and left ventricular ejection fraction (LVEF) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods STEMI patients (n=416) with emergency percutaneous coronary intervention (PCI) and 3-month follow-up were chosen from Jan. 2011 to Dec. 2013, and divided into ambulance-catheter room group (group 1) and ambulance-emergency department-catheter room group (group 2). The target vascular lesion and Killip grading were recorded, and vascular-opening time and changes of LVEF at hospitalization time and 3 m after PCI were compared in 2 groups. Results The baseline, target vascular lesion and Killip grading had no statistical difference (P>0.05), and duration of symptom attack-hospitalization had no statistical difference (P>0.05) between 2 groups. The mean DBT [(44.3±11.8) min vs. (82.9±12.6) min] and symptom attack-vascular-opening time [(511.8 ±219.9) min vs. (558.6±245.6) min] were higher in group 1 than those in group 2 (P<0.05). LVEF was similar in 2 groups at hospitalization time, but after PCI for 3 m, LVEF and added value of LVEF were higher in group 1 than those in group 2 (P<0.05). Conclusion The mode of ambulance-catheter room can shorten DBT and symptom attack-vascular-opening time, and improve left heart function 3 m after PCI in STEMI patients with emergency PCI.