不同来院途径急性ST段抬高性心肌梗死再灌注时间对比分析.docVIP

不同来院途径急性ST段抬高性心肌梗死再灌注时间的对比分析 　　【摘要】 目的 分析胸痛中心建?O初期不同来院途径急性ST段抬高性心肌梗死（STEMI）患者再灌注时间的差异， 找出今后需要着力改进的诊疗环节。方法 回顾性分析210例行急诊冠状动脉（冠脉）介入治疗（PPCI）STEMI患者的临床资料， 根据来院途径的不同方式分为120组（43例）、转院组（60例）及自行来院组（107例）。记录再灌注的关键时间点：患者发病时间、首次医疗接触（FMC）时间、至医院大门时间、球囊扩张时间， 并统计分析三组再灌注时间的差异。结果 转院组门-球时间43 min最短， 自行来院组88 min最长， 三组比较差异有统计学意义（P0.05）；转院组FMC-球囊时间249 min最长， 与其他两组比较差异有统计学意义（P0.05）；转院组发病-球囊时间394 min最长， 与其他两组比较差异有统计学意义（P0.05）。总平均门-球时间76 min、发病-FMC时间141 min、FMC-球囊时间110 min、发病-球囊时间303 min。结论 门-球时间不能完全代表STEMI救治的能力， 发病-球囊时间才是衡量地区STEMI救治的真实水平， 胸痛中心建设应以建立区域协同救治体系、提高社区居民的健康意识， 最终缩短患者发病后的总缺血时间为目的。 　　【关键词】 来院途径；心肌梗死；再灌注时间；血管成形术；胸痛中心 　　DOI：10.14163/j.cnki.11-5547/r.2018.09.009 　　【Abstract】 Objective To analyze the difference of reperfusion time in patients with acute ST segment elevation myocardial infarction （STEMI） by different approaches to hospital during the early stage of chest pain center， and find out diagnosis and treatment links that need to be improved in the future. Methods The clinical data of 210 cases of emergency primary percutaneous coronary intervention （PPCI） STEMI patients was retrospectively analyzed. All patients were divided by different approaches to hospital into 120 group （43 cases）， hospital transfer group （60 cases） and hospital self-coming group （107 cases）. The key time points of reperfusion were recorded： the onset time of patients， first medical contact time （FMC）， time of hospital access and time of balloon expansion， and the difference of reperfusion time between the three groups was statistically analyzed. Results Hospital transfer group had shortest door-to-balloon time as 43 min， and hospital self-coming group had longest time as 88 min， and the difference was statistically significant （P0.05）. Hospital transfer group had longest FMC-to-balloon time as 249 min， and it had statistically significant difference comparing with the other two groups （P0.05）. Hospital transfer group had longest onset-to-balloon time as 394 min， and it had statistically significant di