辽西地区不同转运途径对急性ST段抬高型心肌梗死救治情况和短期预后的影响

目的：分析辽西地区不同转运方式对急性ST段抬高型心肌梗死(STEMI)患者救治情况及短期预后的影响。方法：纳入辽西地区2家医院共571例STEMI患者，根据患者的转运情况将患者分为自行转运组和救护车转运组。详细记录两组患者的临床资料、症状发作到首次医疗接触时间（Symptom-to-FMC，STF）、溶栓的比例、急诊PCI的比例、住院总费用、住院期间不良心血管事件和出院后1个月二级预防用药情况及不良心血管事件发生率。结果：急救车组例189例（33.1%），自行转运组382例（66.9%）。救护车组STF时间显著短于自行就诊组(12.3h±5.3h比10.2h±4.9h，P<0.001)。救护车组溶栓的比例显著高于自行就诊组（15.3%比7.9%，p=0.006）。救护车组急诊PCI的比例显著高于自行就诊组（15.9%比9.9%，p=0.040）。两组间住院期间不良心血管事件无显著差异（13.4%比10.6%，P=0.345）。急救车组出院后1个月规律使用二级预防用药比例显著高于自行转运组（60.3%比50.8%，P=0.032）。自行转运组出院后1个月MACE发生率显著高于急救车组（13.6%比7.9%，P=0.047）。结论：急救车转运可缩短STEMI患者缺血时间，降低不良心血管事件，改善预后。

Effect of different transportation mode on the treatment and short-term prognosis of acute ST segment elevation myocardial infarction in western Liaoning Province

Objective: To analyze the effect of different medical insurance in western Liaoning Province on the treatment and short-term prognosis of patients with acute ST segment elevation myocardial infarction (STEMI). Methods: A total of 571 patients with STEMI were enrolled in 2 hospitals in western Liaoning Province. The patients were divided into self-transport group and ambulance-transport group according to the transportation mode in admission. Clinical data, the onset of symptoms to the first medical contact time (Symptom-to-FMC, STF), intravenous thrombolysis, the proportion of PPCI, major adverse cardiovascular events(MACE) during hospitalization and secondary prevention of medication and the incidence rate of MACE 1 months after discharge were recorded in detail. Results: self-transport group 189 cases (33.1%), ambulance-transport group 382 cases (66.9%). The STF time of ambulance-transport group was significantly shorter than that of self-transport group(12.3h±5.3h to 10.2h±4.9h, P<0.001). The proportion of thrombolysis in the ambulance-transport group was significantly higher than that in the self-transport group (15.3% vs 7.9%, p=0.006). The proportion of emergency PCI in ambulance group was significantly higher than that in self-transport group (15.9% vs 9.9%, p=0.040). There was no significant difference in adverse cardiovascular events between the two groups during the period of hospitalization (13.4% vs 10.6%, P=0.345). The proportion of regular secondary prevention of medication 1 months after discharge significant higher in the ambulance-transport group (60.3% versus 50.8%, P=0.032). The incidence of MACE was significantly higher in ambulance-transport group than that of ambulance-transport group 1 months after discharge(13.6% vs 7.9%, P=0.047). Conclusion: Conclusion: emergency vehicle transport can reduce the ischemic time of STEMI patients, reduce the adverse cardiovascular events, and improve the prognosis.