急诊PCI抢救急性心肌梗死在基层医院的扩展性分析

目的探讨在基层医院现有条件下急性心肌梗死病人急诊PCI治疗的影响因素、治疗效果及难度可行性评价等。方法采用急诊PCI治疗组与符合条件的非PCI治疗组和非急诊PCI治疗组两两对照资料分析,观察心脏事件、主要心血管事件(包括不稳定型心绞痛、非致命性心肌梗死、非致死性心力衰竭和死亡)和总的心脏性死亡的发生率、心功能、心肌酶峰前移情况,并随机抽取等量同期非急诊PCI病人(心绞痛/心肌梗死)的冠脉操作资料,统计冠脉病变的类型、平均手术时间、术中并发症以及需置支架的长度、直径和数量等并做对比,评价急诊冠脉支架的难易度。结果①综合素质较高的病人容易接受手术,受益大。表现在手术组病人城市(21例)>农村(1例);干部+自由职业者(17例)>工人+农民(6例);高中以上学历者(16例)>高中以下学历者(包括高中,5例);疾病意识强,家属及本人接受手术率100%。发病后到院的平均时间两组无统计学意义。②急诊手术组病人治疗效果好、恢复快、LVEF不受影响(52.78±14.21)%,并发症少(心绞痛9%、心律失常36.36%,P<0.01或P<0.05),酶峰前移(P<0.01)、死亡率低(本组无死亡)。③急诊手术一般难度不大,多处复杂病变较少(P<0.01),因患者血管弹性好,故开通容易、开通时间短(P<0.01)、手术快、术后恢复好,术中并发症比较凶险(P<

Xtended analysis on rescue treatment by emergency PCI for patients with acute myocardial infarction at basic-level hospital

Objective To discuss the affecting factors, treatment results, difficulty and feasibility evaluation of emergency PCI treatment for patients with acute myocardial infarction at basic-level hospital under the existing conditions. Methods To adopt data comparison method on the two groups between and among emergency PCI treatment team, eligible non-PCI treatment team and non-emergency PCI treatment team, observe cardiac incident, major cardiovascular incident (including unstable angina pectoris, non-fatal myocardial infarction, non-fatal cardiac failure and death) and general cardiac death occurring rate, cardiac function and cardiac enzyme peak forward movement and other conditions, and randomly take same-volume and same-period cardiovascular operation data of non-emergency PCI patients (with angina pectoris / myocardial infarction problem), make statistic of cardiovascular pathology type, average operation time, in-operation complication, and length, diameter and quantity of the stent that is needed. To evaluate the difficulty of emergency cardiovascular stenting based comparison on above-said information. Results A. The patients with higher comprehensive quality are easier to accept the surgery and benefits more. This can be supported by the following comparison among the patients who take surgeries: city residents (21) greater than village residents (1), cadres plus free professions (17) greater than workers plus peasants (6), education background above senior high school (16) greater than education background at or lower than senior high school (5). The greater group has high awareness of disease and the surgery rate accepted by the patients or family reaches 100%. But the average time of visiting the hospital after failing in to illness is about the same. B. The emergency surgery patients have gotten better treatment results, quicker recovery and the LVEF is not affected (57.28+14.21)%, the complication is seldom (angina pectoris 9%, irregular heart beat 36.36%,P<0.01 or P<0.05=, cardiac enzyme peak forward movement (P<0.01=, the death rate is very low (no death report in this group); C. The emergency surgery is not very difficult in general with little complicated pathology (P<0.01=, the blood vessel is elastic and easy to open with short opening time (P<0.01=, the surgery is quick and easy to recover, the complication is dangerous (P<0.01=, but it is easy to handle and corrected on a timely basis. Conclusion Call on improvement the technical and equipment condition at the basic-level hospital, in particular emergency PCI technology. Raise the patients' disease prevention and treatment awareness, waste no time for medical treatment, the patients benefits more than the danger from the surgery. Though there is risk from the surgery, the surgery difficulty is not great, the shorter surgery time, the better. And,it is very important to improve the technique and equipment expecially to improve the technique of emergery PCI.