院前心电图对ST段抬高型心肌梗死患者进门至再灌注时间的影响

目的观察院前12导联心电图对急性ST段抬高心肌梗死(STEMI)患者进门至再灌注时间的影响。方法多中心现况调查2006年1～12月期间就诊于北京市19所医院并接受再灌注治疗的急性STEMI患者。根据有无院前心电图分为有心电图组和无心电图组。结果 635例患者中,接受直接经皮冠脉介入治疗(PPCI)者506例(79.7%),其中有心电图者211例(41.7%),无心电图者295例(58.3%);接受溶栓者129例(20.3%),其中有心电图者46例(35.7%),无心电图者83例(64.3%)。院前心电图可显著缩短进门-球囊扩张时间(中位数,120 min比150 min;P0.01),而对进门-溶栓时间(中位数,74min比93min;P=0.168)无影响。有心电图组进门90min内完成球囊扩张的比例显著高于无心电图组(24.6%比15.9%,P=0.017)。无论接受何种再灌注治疗,院前心电图对住院病死率无影响。结论院前心电图可显著缩短STEMI患者的进门-球囊扩张时间。应进一步提高院前心电图完成率。

Impact of prehospital 12-lead electrocardiogram on door-to-reperfusion time in patients with ST-segment elevation myocardial infarction

Objective To evaluate the effect of prehospital 12-lead electrocardiogram ECG） on door-to- reperfusion time in patients with ST-segment elevation myocardial infarction （STEMI）. Methods From January to December 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing. Six hundred and thirty five patients with STEMI received thrombolysis or primary percutaneous coronary intervention （ PPCI ） were enrolled. Participants were divided into prehospital ECG group and non-prehospital ECG group. Results Among 506 patients （79. 7% ） received PPCI, 211 （41.7%）had prehospital ECG, and the remaining 295 （58.3%）had no prehospital EGG. Among 129 patients （ 20. 3% ） received thrombolysis, 46 （ 35.7% ） had prehospital ECG, while 83 （ 64. 3% ） had no prehospital ECG. The prehospital ECG was associated with a significantly shorter median door-to-balloon time （ 120 min vs. 150 min, P 〈 0. 01 ） , and did not influence the median door-to-needle time （74 min vs. 93 rain, P = 0. 168 ）. The proportion of patients received balloon dilation within the guideline-recommended 90 min timeframes was significantly higher in prehospital ECG group than in non-prehospital ECG group （24. 6% vs. 15.9% ,P =0. 017）. The inhospital mortality was not different between 2 groups. Conclusions Prehospital ECG is associated with a significantly shorter door-to-balloon time in STEMI patients. Prehospital EGG recording is recommended in patients suspected STEMI.