优化综合急救流程对急性ST段抬高型心肌梗死患者的综合分析及效果评价

目的分析优化院内综合急救流程对行直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者救治效果的影响,探讨影响院内综合急救流程的主要因素和改进措施。方法纳入2017年7月至2018年12月青岛大学附属医院确诊的STEMI患者。2017年7月至2018年3月在胸痛中心建设、优化综合急救流程前行直接PCI患者为改进前组(92例),2018年4月至2018年12月在胸痛中心建设、优化综合急救流程后行直接PCI患者为改进后组(87例)。观察并对比两组从进入医院大门到球囊扩张血管再疏通(D to B)时间、住院天数及随访3个月主要不良心血管事件(MACE,包括再发心肌梗死、心律失常、心原性休克、心力衰竭)发生率。结果改进前组患者节点1(17.21±5.11)min比(4.44±0.76)min,P<0.001]、节点2(10.40±4.49)min比(5.68±0.77)min,P<0.001]、节点342.50(23.00,74.00)min比22.00(18.00,25.00)min,P<0.001]、节点4(40.99±8.70)min比(22.71±4.01)min,P<0.001]、节点5(5.51±1.04)min比(3.82±0.71)min,P<0.001]、节点9(74.45±2.41)min比(16.83±0.92)min,P<0.001]、节点10(22.78±4.12)min比(17.82±0.95)min,P<0.001]时间和D to B时间(155.10±67.94)min比(83.20±14.74)min,P<0.001]均显著长于改进后组患者,差异均有统计学意义。两组节点6、节点7、节点8时间比较,差异均无统计学意义(均P>0.05)。改进后组患者节点1(4.44±0.76)min比10 min,P<0.001]、节点2(5.68±0.77)min比10 min,P<0.001]、节点5(3.82±0.71)min比10 min,P<0.001]、节点9(16.83±0.92)min比20 min,P<0.001]时间较标准节点时间有很大改进,差异均有统计学意义,虽然节点3、节点4、节点8时间与标准节点时间比较,差异均无统计学意义(均P>0.05),但均符合标准时间。改进后组患者D to B整体平均时间(83.20±14.74)min比90 min,P<0.05]短于标准时间,差异有统计学意义。改进后组患者随访3个月后MACE发生率(10.3%比25.0%,P=0.011)显著低于改进前组患者,平均住院时间(6.67±0.77)d比(8.04±2.52)d,P<0.001]显著短于改进前组患者,差异均有统计学意义。结论优化院内综合急救流程明显缩短了D to B时间,使得STEMI患者3个月总体心血管不良事件发生率显著降低。

Comprehensive analysis and eff ect evaluation of optimizing comprehensive emergency procedure for acute ST-segment elevation myocardial infarction

Objective This study aimed at optimizing hospital comprehensive emergency process line for primary percutaneous coronary intervention(PCI)of acute ST segment elevation myocardial infarction(STEMI)patients.In addition,this study was used to analyze the main factors affecting the hospital's comprehensive emergency procedures and improve measures,and provide theoretical guidance and suggestions for further improving the hospital’s comprehensive emergency procedures.Methods From July 2017 to March 2018,92 STEMI patients who underwent emergency PCI and met the inclusion criteria in the affiliated hospital of Qingdao university during the routine procedure were selected to form the pre-improvement group.The improved group was composed of 87 STEMI patients who underwent primary PCI and met the inclusion criteria after optimizing the comprehensive emergency treatment process under the background of the establishment of chest pain center in our hospital from April,2018 to December,2018.The data of this study were obtained from the emergency greenway mobile APP developed by the affi liated hospital of Qingdao university and Beijing Anlong Maide medical technology.The D to B time,hospitalization days,major adverse cardiovascular events(MACE)at 3 months follow-up including recurrent myocardial infarction,arrhythmia,cardiogenic shock and heart failure were observed.Results The time of node 1,node 2,node 3,node 4,node 5,node 9,node 10 and D to B in the improved group was shorter than that in the improved group,and the diff erence between the two groups was statistically signifi cant(P<0.05).There was no signifi cant diff erence in node 6,node 7 and node 8 between the two groups(P>0.05).The 3-month overall incidence of MACE in the improved group was signifi cantly lower than that in the former group,and the diff erence between the two groups was statistically signifi cant(P<0.05).Node 3,node 4 and node 8 in the improved group did not meet the international standard for average time,and the remaining time met the standard.Conclusions D to B time was signifi cantly shortened by optimizing the comprehensive emergency procedures in the hospital,resulting in a signifi cant reduction in the overall incidence of cardiovascular adverse events after 3 months for STEMI patients.