胸痛中心对急性ST段抬高型心肌梗死患者救治效果的作用研究

目的 探讨胸痛中心对急性ST段抬高型心肌梗死患者救治效果的作用。 方法 选择新疆医科大学第一附属医院胸痛中心成立前后各24个月(2013年10月—2017年9月)收治的明确诊断为急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)并直接行PCI术的患者685例，按照时间先后顺序分为院内绿色通道组(胸痛中心成立前24个月，即2013年10月—2015年9月)274例、胸痛中心组(胸痛中心成立后24个月，即2015年10月—2017年9月)411例。比较2组患者总缺血时间、发病至首次医疗接触的时间(first medical contact，FMC)时间、FMC至球囊扩张(FMC2B)时间、就诊至球囊扩张(D2B)时间、知情同意时间、救护车或转诊到院比例、院内病死率、经皮冠状动脉介入治疗(primary percutaneous coronary intervention，PPCI)后院内心衰率、CCU时间、住院时间和总费用。 结果 胸痛中心组与院内绿色通道组比较，总缺血时间[(322.6±112.8)min vs. (445.2±90.9)min，P＜0.001]、发病至FMC时间[(194.9±90.5)min vs. (270.4±112.9)min，P＜0.001]、FMC2B时间[(118.7±68.4)min vs. (158.7±77.3)min，P＜0.001]、D2B时间[(73.2±25.4)min vs. (110.9±43.9)min，P＜0.001]、知情同意时间[(10.9±5.2)min vs. (22.4±15.6)min，P＜0.001]均显著缩短；院内病死率(1.2% vs. 3.6%，P=0.033)、PPCI术后院内心力衰竭率(14.4% vs. 28.1%，P＜0.001)均显著降低；CCU时间[(2.6±0.8)d vs. (3.8±0.6)d，P＜0.001]、住院时间[(7.9±3.7)d vs. (9.5±3.8)d，P＜0.001]均显著缩短；总费用[(4.6±2.1)万元 vs. (5.1±2.0)万元，P=0.002]显著降低。 结论 胸痛中心能显著提高急性STEMI患者救治效果，改善患者短期预后。 

Effect of chest pain center on the treatment of patients with acute ST-segment elevation myocardial infarction

Objective To investigate the effect of chest pain center (CPC) on the treatment of patients with acute ST-segment elevation myocardial infarction. Methods A total of 685 patients with acute STEMI and direct percutaneous coronary intervention were enrolled in the first affiliated hospital of Xinjiang medical university for 48 months (between October 2013 and September 2017) before and after the establishment of the cpc. The acute STEMI patients were divided into 274 cases of green channel group in the hospital and 411 cases of CPC group. The total ischemic time, onset-first medical exposure (FMC) time, FMC-balloon dilatation (FMC2B) time, visit-balloon dilatation (D2B) time, informed consent time, ambulance or referral proximity to hospital, in-hospital mortality, post-PCI heart failure, CCU time, length of hospital stay, and total cost were compared. Results Compared with the green channel group in the hospital, the total ischemic time of CPC group [(322.6±112.8) min vs. (445.2±90.9) min, P<0.001], the onset to FMC time [(194.9±90.5) min vs. (270.4±112.9) min, P<0.001], FMC2B time [(118.7±68.4) min vs. (158.7±77.3) min, P<0.001], D2B [(73.2±25.4) min vs. (110.9±43.9) min, P<0.001], informed consent time [(10.9±5.2) min vs. (22.4±15.6) min, P<0.001] were significantly shortened. In-hospital mortality (1.2% vs. 3.6%, P=0.033), in-hospital heart failure after PCI (14.4% vs. 28.1%, P<0.001), CCU time [(2.6±0.8) d vs. (3.8±0.6) d, P<0.001], hospitalization time [(7.9±3.7) d vs. (9.5±3.8) d, P<0.001] were significantly shortened. Total cost [(4.6±2.1) ten thousand yuan vs. (5.1±2.0) ten thousand yuan, P=0.002] was significantly decreased. Conclusion The chest pain center can significantly improve the treatment effect of patients with acute STEMI and improve the short-term prognosis of patients.