基层医院急性心肌梗死转运介入治疗与就地抢救治疗的疗效及预后比较

目的追踪比较基层医院急性心肌梗死(AMI)转运介入治疗与就地抢救治疗的疗效及预后。方法追踪观察2005年以来由揭东县人民医院转至汕大医学院第一附属医院行急诊介入治疗的AMI患者37例的预后(包括死亡、再次心肌梗死、心力衰竭、恶性心律失常以及再次入院的发生率),追踪比较同期在揭东县人民医院行溶栓/保守治疗的AMI患者39例的预后。结果转运组转送过程无死亡,全部成功施行急诊冠状动脉介入治疗,术后2例死亡,至2009年底有5例再次住院(3例因合并心力衰竭,2例因出现频发室性早搏)。溶栓/保守组39例中死亡11例(9例死于AMI急性期,2例于出院后1个月在家猝死),12例再次住院(再发心肌梗死1例,6例并发心力衰竭,5例合并恶性心律失常)。结论基层医院AMI患者转送至附近大医院行急诊冠状动脉介入治疗不仅是安全的,而且获益更大。

Comparison of Efficacy and Prognosis about Transferring Percutaneous Coronary Intervention Superior to On-site Thrombolysis or Drugs Treatment in Acute Myocardial Infarction in Primary Hospital

Objective Following-up and comparing the prognosis of acute myocardial infarction by transferring percutaneous coronary intervention or onsite thrombolysis or drugs treatment in primary hospital.Methods Mortality,re-myocardial infarction,heart failure,malignant arrhythmia and random were observed in 37 acute myocardial infarction patients who were transferred to 1st affiliated hospital,Shantou university medical college for emergency percutaneous coronary intervention （transferring group） and 39 acute myocardial infarction cases who received on-site thrombolysis or drugs treatment in our hospital （thrombolysis/drugs group） from 2005 in Jiedong people＇s hospital.Results There was no death during transferring and all the transferred cases were performed emergency percutaneous coronary intervention successfully with 2 deaths after percutaneous coronary intervention,5 readmissions （3 with heart failure,2 with malignant arrhythmia） were recorded till December 2009 in transferring group.There were 11 deaths （9 within 7 days in the hospital,2 sudden death at home after discharge for about 1 month）,12 readmissions （6 with heart failure,5 with malignant arrhythmia,1 with re-myocardial infarction） in the thrombolysis/drugs group till now.Conclusion For the acute myocardial infarction cases in primary hospitals,transferring percutaneous coronary intervention is not only safe,but also benefit the patients furthermore than on-site thrombolysis or drugs treatment.