陈淮沁副教授MBBS,MMed(IntMed),FAMS,MRCP(UK),.pptVIP

?Hospitals Before After p-value TTSH mean (sd) Data not available yet CGH mean (sd) 99.52 (39.76), Median=88 73 (21.18 ), Median=74 0.023* NUH mean (sd) 85.45 (51.98), Median=63 42.45 (14.13), Median=40 0.001* SGH mean (sd) 94.06 (26.08), Median=91 79.5 (6.36), Median=79.5 0.431 AH mean (sd) Data not available yet Overall mean (sd) 93.89 (29.81), Median=90 56.85 (22.78), Median=46 0.001* 入院前心电图检测计划: D2B 时间  结 论 在国立大学卫生系统，通过改变工作流程，达到了门 诊-球囊时间中位 数 58 分钟 和 83% 患者90分钟内获 得了急诊PCI的成就(急诊科和心内科通力合作) 延迟门诊-球囊时间与急诊PCI STEMI患者院内 死亡风险增高相关 时间就是心肌 实施急诊PCI的医院应该将 D2B 90 分钟作为系 统目标 院前 ECG 和区域化护理 (改良的健康路径)将会 进一步缩短D2B时间和提高 STEMI患者的治疗 效果 重新定义 ‘入门时间’ 为 “第一接触时间” 1-3 July 2010 * * Varied strategies; none universally accepted * Page 71 (Table T61) Every minute delay does count: not only for Lytics, but also for P-PCI * * Note here that in terms of adjusted mortality rates, reducing D2B from 90 minutes (current standard) to 60 minutes would save almost 1 additional life (0.8 lives) per hundred patients, and from 90 minutes to 30 minutes would save an additional 1.3 lives per hundred PDSA Plan-Do-Study-Act * * * Here we see D2B trends and note a decreased from 1994 to 2006 of 33 minutes and from 2000 to 2006 of 20 minutes—i.e., most of the improvement occurred after 2000 with the increased emphasis on D2B! * EMD nurses’ anxiety, cannot find oxygen point or electrical outlets. Claimed have to wait 25 mins. * 陈淮沁副教授 MBBS, M Med(Int Med), FAMS, MRCP(UK), FRCP(Edinburgh), FACC, FSCAI 新加坡国立大学心脏中心总监 新加坡国立大学杨潞齡医学院副教授 缩短急性ST段抬高心肌梗死病人 急诊介入治疗门-球囊时间 CIT 2010 Beijing, China 时间就是心肌 梗死面积决定结果 0 20 40 60 80 100 0 4 8 12 16 20 24 症状发作到再灌注治疗时间, h 死亡率降低 (%) CM Gibson 3 hrs 时间依赖关键期 非时间依赖期 目标：挽救心肌 目标：开通梗死相关动脉 D C B A 挽救心肌范围 Gersh BJ et al JAMA 2005; 293: 979 23个 PCI vs 溶栓 随机实验荟萃分析 (n=7739) PCI Lytics 7% 7% 5% 9% 死亡 (伴休克) 1% p=0.0002 p=0.0003 (%) Events 死亡 (不伴休克) 非致命性再梗 卒中总数 出血性脑血管病 0