区域协同救治体系在ST段抬高型心肌梗死患者行转运急诊经皮冠状动脉介入治疗中的作用

目的分析区域协同救治体系在ST段抬高型心肌梗死(STEMI)患者行转运急诊经皮冠状动脉介入治疗(PCI)中的作用。方法选取2017年1月-2019年6月成都地区8家具备PCI能力并建立胸痛中心的三级综合医院收治的行转运急诊PCI的STEMI患者347例。2018年上述8家医院完成区域协同救治体系建立工作,并根据入院时间将所有患者分为A组173例(2017年1月-2018年6月)和B组174例(2018年7月-2019年6月)。比较两组患者关键救治时间节点[包括发病至首次医疗接触(SO-to-FMC)时间、首次医疗接触至到达PCI医院大门(FMC-to-D)时间、到达PCI医院大门至首次球囊扩张(D-to-B)时间、首次医疗接触至首次球囊扩张(FMC-to-B)时间、发病至首次球囊扩张(SO-to-B)时间及SO-to-FMC时间、FMC-to-B时间、D-to-B时间达标率]、救治效果(包括院内死亡及PCI后心功能指标)、住院费用及住院时间;STEMI患者院内死亡及PCI后LVEF<50%、局部室壁运动障碍影响因素的分析均采用多因素Logistic回归分析。结果(1)两组患者SO-to-FMC时间、FMC-to-D时间及SO-to-FMC时间达标率比较,差异无统计学意义(P>0.05);B组患者D-to-B时间、FMC-to-B时间、SO-to-B时间短于A组,D-to-B时间、FMC-to-B时间达标率高于A组(P<0.05)。(2)两组患者PCI后室壁瘤发生率、住院费用及住院时间比较,差异无统计学意义(P>0.05);B组患者院内病死率及PCI后LVEF<50%者所占比例、局部室壁运动障碍发生率低于A组(P<0.05)。(3)多因素Logistic回归分析结果显示,B组患者院内死亡、PCI后LVEF<50%、PCI后局部室壁运动障碍发生风险分别是A组患者的0.241倍[95%CI(0.063,0.925)]、0.368倍[95%CI(0.173,0.784)]、0.509倍[95%CI(0.287,0.901)](P<0.05)。结论区域协同救治体系有利于缩短行转运急诊PCI STEMI患者的D-to-B时间、FMC-to-B时间、SO-to-B时间,降低院内病死率,改善PCI后心功能,但对减少SO-to-FMC时间延误无明显效果。

Effect of Regional Synergistic Treatment System on STEMI Patients Transferred to Perform Emergency Percutaneous Coronary Intervention

Objective To analyze the effect of Regional Synergistic Treatment System on STEMI patients transferred to perform emergency percutaneous coronary intervention(PCI).Methods From January 2017 to June 2019,a total of 347 STEMI patients who were transferred to emergency PCI from 8 tertiary general hospitals with PCI ability and establishedChest Pain Centerwere selected in Chengdu.The above 8 hospitals completed the establishment of Regional Synergistic Treatment System in 2018,and all of the 347 patients were divided into A group(admitted to hospital from January 2017 to June 2018,n=173)and B group(admitted to hospital from July 2018 to June 2019,n=174)according to the time of admission.Critical treatment time nodes(including SO-to-FMC time,FMC-to-D time,D-to-B time,FMC-to-B time,SO-to-B time,good control rate of SO-to-FMC time,FMC-to-B time and D-to-B time),treatment effect(including death during hospitalization and index of cardiac function after PCI),hospitalization cost and hospital stays were compared between the two groups;influencing factors death during hospitalization,LVEF<50%and regional wall motion abnormalities after PCI in patients with STEMI were analyzed by multivariate Logistic regression analysis.Results(1)There was no statistically significant difference in SO-to-FMC time,FMC-to-D time or good control rate of SO-to-FMC time between the two groups(P>0.05);D-to-B time,FMC-to-B time and SO-to-B time in B group were statistically significantly shorter than those in A group,while good control rate of D-to-B time and FMC-to-B time in B group were statistically significantly higher than those in A group(P<0.05).(2)There was no statistically significant difference in incidence of ventricular aneurysm after PCI,hospitalization cost or hospital stays between the two groups(P>0.05);hospital fatality rate,proportion of patients with LVEF<50%after PCI and incidence of regional wall motion abnormalities in B group were statistically significantly lower than those in A group(P<0.05).(3)Multivariate Logistic regression analysis results showed that,risk of death during hospital,LVEF<50%and regional wall motion abnormalities after PCI in B group was 0.241 times[95%CI(0.063,0.925)],0.368 times[95%CI(0.173,0.784)]and 0.509 times[95%CI(0.287,0.901)]than that in A group,respectively(P<0.05).Conclusion In STEMI patients transferred to perform emergency PCI,Regional Synergistic Treatment System is helpful to shorten the D-to-B time,FMC-to-B time,SO-to-B time,reduce the hospital fatality rate and improve the cardiac function after PCI,but it has no significant effect on SO-to-FMC time delay.