CAJ | 학술논문

目的了解河南省不同级别医院急性ST段抬高型心肌梗死(STEMI)患者的早期再灌注治疗现状.方法采用统一调查表,对2011年6月至2012年6月河南省17家医院(8家三级医院,9家二级医院)的STEMI患者进行登记,收集基线资料、早期再灌注治疗情况和住院病死率等资料.结果共入选1 686例STEMI患者,其中886例患者来自三级医院,800例患者来自二级医院.654例患者接受早期再灌注治疗,其中83.0％(543/654)患者接受溶栓治疗,17.0％(111/654)患者接受直接经皮冠状动脉介入治疗(PCI).三级和二级医院STEMI患者的早期再灌注比例差异无统计学意义[40.1％ (355/886)比37.4％ (299/800),P=0.257].发病-接诊、入门-溶栓和入门-球囊扩张时间中位数分别为132、18和60 min.三级医院STEMI患者的发病-接诊(150 min比120 min,P=0.001)、入门-溶栓(30 min比18 min,P=0.003)及发病-溶栓(3.5h比2.7h,P=0.001)时间中位数均长于二级医院,而不同级别医院患者的入门-球囊扩张、发病-直接PCI和发病-择期PCI时间差异均无统计学意义(P均＞ 0.05).三级医院入门-溶栓时间≤30 min的比例低于二级医院[46.4％(84/181)比62.2％ (153/246),P=0.001],两者入门-球囊扩张时间≤90 min的比例差异无统计学意义[58.8％ (60/102)比57.1％ (4/7),P=1.000].三级和二级医院STEMI患者的住院病死率差异无统计学意义[5.8％ (51/886)比5.5％ (44/800),P=0.820].结论河南省STEMI住院患者早期再灌注比例较低,溶栓是主要的早期再灌注方式;三级医院没有发挥其介入治疗的优势;二、三级医院在早期再灌注治疗上有很大的提高空间.
목적 료해하남성불동급별의원급성ST단태고형심기경사(STEMI)환자적조기재관주치료현상.방법 채용통일조사표,대2011년6월지2012년6월하남성17가의원(8가삼급의원,9가이급의원)적STEMI환자진행등기,수집기선자료、조기재관주치료정황화주원병사솔등자료.결과 공입선1 686례STEMI환자,기중886례환자래자삼급의원,800례환자래자이급의원.654례환자접수조기재관주치료,기중83.0％(543/654)환자접수용전치료,17.0％(111/654)환자접수직접경피관상동맥개입치료(PCI).삼급화이급의원STEMI환자적조기재관주비례차이무통계학의의[40.1％ (355/886)비37.4％ (299/800),P=0.257].발병-접진、입문-용전화입문-구낭확장시간중위수분별위132、18화60 min.삼급의원STEMI환자적발병-접진(150 min비120 min,P=0.001)、입문-용전(30 min비18 min,P=0.003)급발병-용전(3.5h비2.7h,P=0.001)시간중위수균장우이급의원,이불동급별의원환자적입문-구낭확장、발병-직접PCI화발병-택기PCI시간차이균무통계학의의(P균＞ 0.05).삼급의원입문-용전시간≤30 min적비례저우이급의원[46.4％(84/181)비62.2％ (153/246),P=0.001],량자입문-구낭확장시간≤90 min적비례차이무통계학의의[58.8％ (60/102)비57.1％ (4/7),P=1.000].삼급화이급의원STEMI환자적주원병사솔차이무통계학의의[5.8％ (51/886)비5.5％ (44/800),P=0.820].결론 하남성STEMI주원환자조기재관주비례교저,용전시주요적조기재관주방식;삼급의원몰유발휘기개입치료적우세;이、삼급의원재조기재관주치료상유흔대적제고공간.
Objective To observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction (STEMI) hospitalized in tertiary and secondary hospitals in Henan province.Methods Baseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province (8 tertiary hospitals, 9 secondary hospitals) from June 2011 to June 2012 were obtained using a uniformed questionnaire.Results One thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals.Six hundred and fifty four patients (38.8％, 654/1 686) underwent early reperfusion therapy (543 with thrombolysis and 111 with primary percutaneous coronary intervention (PCI)).There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals (40.1％ (355/886) vs.37.4％ (299/800), P =0.257).The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively.The median time from symptom onset to first medical contact (150 min vs.120 min, P =0.001), door-to-needle (30 min vs.18 min, P =0.003) and symptom onset-to-thrombolysis (3.5 h vs.2.7 h, P =0.001) were significantly longer in tertiary hospitals than in secondary hospitals.No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals (all P ＞0.05).The proportion of door-to-needle≤30 min was lower in tertiary hospitals than in secondary hospitals (46.4％ (84/181) vs.62.2％ (153/246), P =0.001).However, there was no difference in the proportion of door-to-balloon ≤90 min between tertiary and secondary hospitals (58.8％ (60/102) vs.57.1％ (4/7), P =1.000).In-hospital mortality was also similar between tertiary and secondary hospitals (5.8％ (51/886) vs.5.5％ (44/800), P =0.820).Conclusions Early reperfusion rate is low, and thrombolysis is the main early reperfusion therapy in both tertiary and secondary hospitals in Henan province.Tertiary hospitals did not take advantage of their primary PCI capability.There is great room for improvement in early reperfusion therapy in tertiary and secondary hospitals.