CAJ | 학술논문

目的对STEMI患者救治流程进行优化改进,分析其对缩短医院延迟时间,提高门囊时间达标率的作用.方法通过分析传统的STEMI流程对医院延迟的影响,对STEMI救治流程进行以下优化改进:(1)由急诊科医师直接启动导管室;(2)导管室值班人员电话单标注距医院时间;(3)启动导管室后立即转运患者至导管室.记录STEMI患者门囊时间构成,具体为5个时间段:(1)入急诊至完成首份心电图;(2)完成心电图至启动导管室;(3)启动导管室至手术开始;(4)手术开始至球囊扩张时间;(5)入急诊至球囊扩张时间.对比2008年5月至2012年12月间112例采用传统救治流程的STEMI患者与2013年1月至2014年12月间126例施行优化流程患者,分析其各时间段的构成变化.结果 (1)优化流程后的门囊时间与传统流程比较明显缩短[(82.68±16.35) min vs.(120.87±22.57) min,P＜0.01];90 min达标率也由12.5％升高至61.1％;(2)从完成心电图到启动导管室时间由传统流程组(38.86±7.59) min减至优化流程组(13.75±5.56) min,P＜0.01;(3)从启动导管室到手术开始时间由(44.37±7.56) min缩短至(30.39±4.94) min,P＜0.01;(4)在优化流程中,手术开始至球囊扩张时间也较传统明显缩短[(34.83±5.97) minvs.(31.33±6.50) min,P＜0.05].结论通过优化STEMI急诊救治流程,特别是缩短急诊室和导管窒的反应时间,明显改善医院延迟,使门囊时间控制在90 min以内.
목적 대STEMI환자구치류정진행우화개진,분석기대축단의원연지시간,제고문낭시간체표솔적작용.방법 통과분석전통적STEMI류정대의원연지적영향,대STEMI구치류정진행이하우화개진:(1)유급진과의사직접계동도관실;(2)도관실치반인원전화단표주거의원시간;(3)계동도관실후립즉전운환자지도관실.기록STEMI환자문낭시간구성,구체위5개시간단:(1)입급진지완성수빈심전도;(2)완성심전도지계동도관실;(3)계동도관실지수술개시;(4)수술개시지구낭확장시간;(5)입급진지구낭확장시간.대비2008년5월지2012년12월간112례채용전통구치류정적STEMI환자여2013년1월지2014년12월간126례시행우화류정환자,분석기각시간단적구성변화.결과 (1)우화류정후적문낭시간여전통류정비교명현축단[(82.68±16.35) min vs.(120.87±22.57) min,P＜0.01];90 min체표솔야유12.5％승고지61.1％;(2)종완성심전도도계동도관실시간유전통류정조(38.86±7.59) min감지우화류정조(13.75±5.56) min,P＜0.01;(3)종계동도관실도수술개시시간유(44.37±7.56) min축단지(30.39±4.94) min,P＜0.01;(4)재우화류정중,수술개시지구낭확장시간야교전통명현축단[(34.83±5.97) minvs.(31.33±6.50) min,P＜0.05].결론 통과우화STEMI급진구치류정,특별시축단급진실화도관질적반응시간,명현개선의원연지,사문낭시간공제재90 min이내.
Objective To optimize the treatment strategy in patients with acute ST-segment elevation myocardial infaretion (STEMI) in order to shorten the system delay,achieving the goal door-to-balloon (DTB) as soon as possible.Methods After the analysis of the influence on system delay of conventional treatment process,the following algorithm taken to optimize the treatment process in STEMI patients was carried out:(1) emergency department physician had the activation of the catheterization laboratory and the STEMI protocol;(2) catheterization laboratory staff on duty marked the distances to our hospital on the card with telephone number;(3) immediate transfer the patient directly to an immediately available catheterization lab on activation by an emergency team.There are 5 periods in the door-to-balloon time:(1) door to ECG;(2) ECG to activation;(3) activation to procedure start;(4) procedure start to balloon inflation;(5) door to balloon.After implementation of the novel process,the length of time consumed in each period was counted in 126 consecutive STEMI patients treated with the novel process from January 2013 to December 2014 and compared with the previous 112 STEMI patients admitted from May 2008 to December 2012.Results (1) Compared with the conventional treatment process group,the DTB of the optimization treatment process group significantly shortened the time [(82.68 ± 16.35) minutes vs.(120.87 ±22.57) minutes,P＜0.01].The rate of the goal DTB of ＜90 minutes increased from 12.5％ to 61.1％.(2)There was a significant reduction in time elapsed between the initial ECG and catheterization team activation from (38.86 ± 7.59) minutes in conventional process to (13.75 ± 5.56) minutes in optimization process (P ＜0.01).(3) Time required between the catheterization team activation and the start of procedure was reduced from (44.37 ± 7.56) minutes in conventional process to (30.39 ± 4.94) minutes in optimization process (P＜0.01).(4) There was a decrease from (34.83 ±5.97) minutes to (31.33 ±6.50)minutes during the whole course from the start of the procedure to the first balloon inflation (P ＜ 0.05).Conclusions Optimizing the treatment process in patients with STEMI can improve our DTB toward the goal of achieving a guideline-recommended ＜ 90 minutes for all patients.This improvement was largely driven by a decrease in time of the response of emergency room and catheter laboratory.