1004例急性心肌梗死患者临床特点及治疗情况的比较分析

目的 分析比较急性心肌梗死(AMI)患者从就诊到出院的临床特点、院前延误时间(PDT)、就诊及治疗方式等情况.方法 设计统一表格,采用调查问卷方式,收集所有AMI患者临床情况.根据发病时间分A组(2004年3月至2005年3月)、B组(2005年3月至2006年3月)和C组(2006年3月至2007年3月),比较三组患者的临床特点、就诊和治疗情况.结果 2004-2007年北京安贞医院心肺血管疾病医疗抢救中心收治1004例AMI患者.3年中急诊收治的AMI患者绝对人数逐年增加,A、B、c三组人数分别为270例、309例和425例,其中≤40岁的AMI患者比例三组分别为4.4%、9.7%和5.9%;既往有脑血管病史分别为8.1%、5.5%和12.8%;既往有冠心病史分别为19.6%、14.3%和31.0%.随着时间的变化,PDT有所改善,三组PDT分别为149、120和130 min;患者选择急救车就诊比例有所增加,三组分别为57.3%、55.7%和64.8%.3年来患者接受急诊经皮冠状动脉介入治疗(PCI)的比例有所增加,三组分别为62.6%、78.0%和74.5%.所有AMI患者总病死率为5.3%,三组分别为5.2%、5.5%和5.2%,病死率无明显变化.结论 急诊收治的AMI患者绝对人数呈增加(其中多数患者既往有心脑血管疾病史),≤40岁AMI患者比例亦有增加,接受急诊PCI治疗同样增加,但患者PDT有缩短.

Clinical characteristics of and related treatments on 1004 patients with acute myocardial infarction from March 2004 to March 2007

OBJECTIVE: To study the change of baseline clinical characteristics including prehospital delayed time (PDT), modes of transportation and treatment for patients with acute myocardial infarction (AMI) in the past 3 years. METHODS: We used the same questionnaire to accurately collect and retrospectively analyze the data regarding clinical characteristics of all 1004 patients with AMI, who consecutively presented to the Emergency Unit and Emergency Intensive Care Unit (EICU) of Beijing Anzhen Hospital from March 12th 2004 to March 11th 2007. According to the time of onset of the disease, all patients were divided into 3 groups: group A (from Mar. 12th 2004 to Mar. 11th 2005), group B (Mar. 12th 2005 to Mar 11th 2006) and group C (Mar. 12th 2006 to Mar. 11th 2007). Clinical characteristics and treatment were compared. RESULTS: There were significant differences in the number of patients with histories of stroke, coronary artery disease or smoking among the three groups (P < 0.05). No obvious differences in the median of PDT were found among the three groups (P > 0.05). More patients accepted reperfusive therapy in group C compared to group A (P < 0.05), although the mortality rates of AMI among these 3 years were similar. CONCLUSION: Though more people started to have accepted reperfusion therapy, mortality failed to show an obvious decrease. Subject as how to shorten the PDT called for further study.