在急诊科设立胸痛中心对胸痛患者诊疗时间的影响

目的在急诊科设立胸痛中心并研究其对急性胸痛患者诊疗时间的影响。方法在急诊科设立急性胸痛中心，每周开诊3d，时间随机确定，其余时间由急诊科按常规流程对胸痛患者进行诊疗，由研究者对急性胸痛患者的病因和诊疗时间进行注册登记。结果2006年1月至2007年12月因急性非创伤性胸痛就诊北京军区总医院急诊科或胸痛中心的患者共696例，心源性胸痛244例（35％），包括急性心肌梗死141例（20％），不稳定型心绞痛81例（12％），稳定型心绞痛17例（2．4％），主动脉夹层2例（0．3％），急性肺栓塞3例（0．4％）；非心源性胸痛452例（65％），呼吸系统41例（6％），消化系统70例（10％），胸膜骨骼肌肉41例（6％），神经精神或其他299例（42％）。经胸痛中心诊治的胸痛患者的诊疗时间与常规诊疗流程相比都有所缩短。急性心肌梗死（70．1±31．7）min vs（115±40．5）min（P〈0．01）；不稳定型心绞痛（228±54）min vs（264±78）min（P=0．02）；非心源性胸痛（108±66）min vs （126±96）min（P=0．03）。结论急性胸痛患者的病因中，心源性者占35％，以急性心肌梗死和不稳定型心绞痛为主；非心源性者占65％。胸痛中心模式能显著缩短急性胸痛患者的诊疗时间。

Establishment of chest pain center in emergency department of hospital can shorten the diagnosis-and-treatment time for patients with acute chest pain

Objective To investigate the value of the establishment of chest pain center（CPC）in Emergency Department（：D） of hospital in improving the diagnosis-and treatment time for patients with acute chest pain. Methods CPC was establ shed in the ED and there were three open days weekly which were randomly selected. The patients were diagnosed and treated by ED physicians according to routine clinical procedures at the rest time of the week. The causes of chest pain and diagnosis-and-treatment time duration of the patients were recorded. Results Totally 696 nontraumatie chest pain patients visited ED/CPC from January 2006 to December 2007 ,of which 244 （35 %）were cardiac chest pain cases, including 141 （20%）cases of acute myocardial infarction（AMI）,81 （12%）cases of unstable angina pectoris, 17（2.4%）cases of stable angina pectoris,2（0, 3%）cases of acute aortic dissection, and 3 （0.4%）cases of acute pulmonary embolism. 452 cases were noncardiac chest pain patients, including 41 （6 %）cases of respiratory diseases, 70（10 % ） cases of digestive diseases, 41（6 % ） cases of chest wall diseases and, 299 （42 % ） eases of psychological-psychotic diseases or other undetermined clinical conditions. Time for diagnosis and treatment for chest pain patients who visited CPC was significantly shortened,AMI（70.1±31.7）min vs （115±40, 5）min（P〈0.01） ;unstable angina pectoris （228±54）min vs （264±78）min（P=0.02）,noncardiac chest pain （108±66）min vs （126±96）rain（P=0.03）. Conclusion Among acute chest pain patients, cardiac causes account for 35 %, mainly including AMI and unstable angina peetoris, noncardiae causes account for 65 %. Time for diagnosis and treatment for chest pain patients is significantly shortened by CPC pattern.