CAJ | 학술논문

目的：：探讨医疗支援模式对当地急性心肌梗死诊治及预后的影响。方法：复旦大学附属中山医院2010年3月起对云南省曲靖市富源县人民医院进行医疗对口支援活动,选择2010年3月—2014年4月富源县人民医院收治的103例急性心肌梗死患者,将2010年3月—2012年11月收治的51例患者分为 A 组,2012年12月—2014年4月收治的52例患者分为 B 组。对2个时间段内患者的治疗策略、住院天数、用药情况及预后进行比较。结果：103例急性心肌梗死患者中,男性吸烟比例显著高于女性(P <0.05)。只有21例 ST 段抬高型急性心肌梗死患者在发病12 h 之内就诊。B 组 ST 段抬高型急性心肌梗死患者溶栓率高于 A 组(P <0.05)。57例患者获得随访,其中只有约1/3的患者接受了后续的冠脉造影和 PCI 术。B 组住院期间二磷酸腺苷(ADP)受体拮抗剂(氯吡格雷)的使用率高于 A 组(P <0.05)。出院后 ADP 受体拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、氯吡格雷等药物的使用率均明显下降,但2组差异无统计学意义。2组各终点事件发生率差异均无统计学意义(P >0.05)。结论：医疗支援模式提高了住院期间心肌梗死的诊断率和治疗规范性。但住院前的就诊时间仍没有缩短,出院后二级预防治疗不规范,说明除了加强住院期间的医疗诊治能力外,仍需加大对患者的健康教育和基层医护人员的培训,并加强区域合作。
목적：：탐토의료지원모식대당지급성심기경사진치급예후적영향。방법：복단대학부속중산의원2010년3월기대운남성곡정시부원현인민의원진행의료대구지원활동,선택2010년3월—2014년4월부원현인민의원수치적103례급성심기경사환자,장2010년3월—2012년11월수치적51례환자분위 A 조,2012년12월—2014년4월수치적52례환자분위 B 조。대2개시간단내환자적치료책략、주원천수、용약정황급예후진행비교。결과：103례급성심기경사환자중,남성흡연비례현저고우녀성(P <0.05)。지유21례 ST 단태고형급성심기경사환자재발병12 h 지내취진。B 조 ST 단태고형급성심기경사환자용전솔고우 A 조(P <0.05)。57례환자획득수방,기중지유약1/3적환자접수료후속적관맥조영화 PCI 술。B 조주원기간이린산선감(ADP)수체길항제(록필격뢰)적사용솔고우 A 조(P <0.05)。출원후 ADP 수체길항제、β수체조체제、혈관긴장소전환매억제제(ACEI)、록필격뢰등약물적사용솔균명현하강,단2조차이무통계학의의。2조각종점사건발생솔차이균무통계학의의(P >0.05)。결론：의료지원모식제고료주원기간심기경사적진단솔화치료규범성。단주원전적취진시간잉몰유축단,출원후이급예방치료불규범,설명제료가강주원기간적의료진치능력외,잉수가대대환자적건강교육화기층의호인원적배훈,병가강구역합작。
Objective:To explore the effects of medical support program on local diagnosis,treatment and prognosis of acute myocardial infarction(AMI).Methods:Department of Cardiology,Zhongshan Hospital,Fudan University launched medical support program for Fuyuan People′s Hospital in Mar 2010.A total of 103 AMI patients admitted to Fuyuan People′s Hospital during Mar 2010 and Apr 2014 were enrolled.And 5 1 patients admitted during Mar 2010 and Nov 2012 were allocated to group A,while 52 patients admitted during Dec 2012 and Apr 2014 were allocated to group B.The treatment strategy,hospital stay, medication and prognosis were compared between the two groups.Results:Among the 103 AMI patients,male smoking pro-portion was significantly higher than female one(P <0.05).Only 21 patients with ST segment elevation myocardial infarction (STEMI)arrived hospital within 12 h.The thrombolytic therapy rate of patients with STEMI in group B was higher than that in group A(P <0.05).The usage rate of adenosine diphosphate(ADP)receptor antagonist(clopidegrel)during hospitalization in group B was higher than that in group A (P <0.05 ).Only 57 patients were followed up.And only 1/3 of these patients re-ceived consecutive coronary angiography and percutaneous coronary intervention(PCI).After discharge from hospital,the pre-scription rates of ADP receptor antagonist,β-receptor blockers and angiotension converting enzyme inhibitor (ACEI)all de-creased obviously and there was no significant difference between the two groups(P >0.05).There was no significant difference regarding the incidence rates of endpoint events between the two groups(P >0.05).Conclusions:Medical support program im-proves the rates of diagnosis and standardized treatment of AMI during hospitalization.However,the delay before admission has not been shortened yet.Furthermore,there was no standardized secondary prevention and treatment after discharge.Thus,apart from improving the ability of diagnosis and treatment during hospitalization,more attention should be paid to the health education for patients and the training for primary medical staff,and enhance the regional cooperation.