转院方式对ST段抬高心肌梗死患者直接PCI及其预后的影响

目的：比较农村地区院间不同转院方式对ST段抬高心肌梗死（ STEMI）患者再灌注及其预后的影响。方法回顾性调查2011年1月至2013年7月间入院、农村地区发病、6 h内完成首次医疗接触（ FMC）并转诊到本院的STEMI患者155例，根据院间转运方式分为基层医院直接转院组（直接转院组）及经一、二级医院逐级转院组（间接转院组），比较2组间早期再灌注情况及住院病死率。结果直接转院组64例、逐级转院组91例；直接转院组中发病12 h内患者接受直接经皮冠状动脉介入治疗（PCI）率高于间接转院组（64．1％ vs．30．8％，P＜0．001），直接PCI比非直接PCI的OR＝4．025（95％ CI 1．934～8．377，P＝0．000），总缺血时间较短〔（6．92±1．89）h vs．（9．37±1．66）h，P＜0．001〕。直接转院组住院死亡1例，逐级转院组住院死亡6例，2组间病死率无显著性差异（1．6％vs．6．6％，P＝0．241），死亡患者均未接受PCI。结论 FMC后的STEMI患者转院至具备PCI条件的医疗单位有较高的直接PCI率；逐级转院方式使更多的患者延迟至12 h以后到达三级医院。

The impact of inter-hospital transfer methods on the prognosis of patients with STEMI and primary PCI treatment

Objective To compare the impact of inter -hospital transfer methods in the rural area on the prognosis of patients with ST -elevation myocardial infarction （ STEMI ） and primary percutaneous coronary intervention （ PCI ） treatment.Method A retrospective survey was made of 155 consecutive STEMI patients , who with the onset of STEMI within 6 h had completed the first medical contacts , been admitted to rural area hospitals and then referred to our hospi-tal.Based on inter-hospital transfer method , the patients were divided into two groups：direct referral first class hospital group and first taken to a secondary class hospital and later transferred to first class hospital group .This study was to compare two groups of early reperfusion time and in -hospital mortality rate .Results Sixty-four cases of STEMI were in direct referral group , 91 cases in indirect referral group .Compared with that in indirect referral group , the rate of the patients received primary PCI within 12 h of onset time was higher in direct referral group （64.1% vs.30.8%, P〈0.001）.Primary PCI vs.non-primary PCI OR was 4.025 （95%CI, 1.934-8.377;P=0.000）.The total ischemic time from the onset of myocardial infarction to reperfusion was shorter （6.92 ±1.89） h vs.（9.37 ±1.66） h, P〈0.001].There was no significant difference in in -hospital mortality between the two groups （1.6% vs.6.6%; P=0.241）.All of the patients who died did not undergo PCI .Conclusion The patients with STEMI who are transferred directly to a first class hospital capable of PCI treatment after the first medical contact have a higher rate of primary PCI treatment.The referral of such cases to a non -PCI capable hospital leads to delay arrival of 12 h after the onset of STEMI to a first class hospital capable of PCI treatment .