胸痛中心建设持续改进对急性ST段抬高型心肌梗死抢救时间及心血管不良事件的影响

何文君; 张小芳; 金瑜; 毛樱

doi:10.16766/j.cnki.issn.1674-4152.002659

胸痛中心建设持续改进对急性ST段抬高型心肌梗死抢救时间及心血管不良事件的影响

doi: 10.16766/j.cnki.issn.1674-4152.002659

何文君^1, ,,
张小芳¹,
金瑜¹,
毛樱²

1.
温州医科大学附属衢州医院(衢州市人民医院)心血管内科，浙江衢州 324000
2.
绍兴市人民医院特殊检查室，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2018KY169

衢州市科技攻关指导性项目 2021010

详细信息

通讯作者:
何文君, E-mail: fc852369@163.com

中图分类号: R542.22 R197.323.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-10
- 网络出版日期: 2022-11-29

Impact of continuous improvement in the construction of the chest-pain centre on the rescue time of acute ST segment elevated myocardial infarction and cardiovascular adverse events

1.
Department of Cardiovascular, the Quzhou Affiliated Hospital of Wenzhou Medical University (Quzhou People's Hospital), Quzhou, Zhejiang 324000, China

摘要

摘要: 目的分析胸痛中心建设持续改进对急性ST段抬高型心肌梗死(STEMI)患者救治效果和不良事件的影响。方法比较2020年11月—2021年8月于温州医科大学附属衢州医院胸痛中心建设持续改进前后收治的186例STEMI患者, 将2020年11月—2021年3月(胸痛中心建设持续改进前)收治的患者作为对照组，2021年4月—2021年8月(胸痛中心建设持续改进后)收治的患者作为观察组，2组患者均为93例。比较2组患者救治时间、主要不良心血管事件发生率及出院后1个月心功能情况。结果观察组患者救治时间各项指标均短于对照组，差异有统计学意义(均P＜0.05);观察组主要不良心血管事件发生率为6.6%，低于对照组(16.1%，P＜0.05);出院后1个月，观察组左心射血分数(LVEF)、血浆脑钠肽(BNP)、6 min步行距离分别为(52.45±6.02)%、(50.91±4.23)pg/mL、(422.07±20.59)m，均优于对照组[(47.62±5.22)%、(68.77±6.81)pg/mL、(391.41±19.45)m，均P＜0.05]。结论胸痛中心建设持续改进不仅能缩短STEMI患者抢救时间，还能减少患者心血管不良事件的发生，改善患者预后，值得临床应用。
- 胸痛中心建设持续改进 /
- 急性ST段抬高型心肌梗死 /
- 抢救时间 /
- 心血管不良事件
Abstract: Objective To analyse the effect of continuous improvement in chest-pain centre on the treatment effect and adverse events of acute ST segment elevation myocardial infarction (STEMI). Methods A total of 186 patients with STEMI within 12 h before and after the establishment of chest-pain centre of Quzhou Hospital Affiliated to Wenzhou Medical University from November 2020 to August 2021 were compared. Patients treated from November 2020 to March 2021 (before the continuous improvement in chest-pain centre construction) served as the control group. Patients treated from April 2021 to August 2021 (after the continuous improvement in chest-pain centre construction) served as the observation group. There were 93 patients in both groups. Treatment time, incidence of major adverse cardiovascular events, and cardiac function at 1 month after discharge were compared between the two groups. Results The treatment time of patients in the observation group was shorter than that in the control group (all P < 0.05). The incidence of major adverse cardiovascular events in the observation group was 6.6%, lower than 16.1% in the control group (P < 0.05). One month after discharge, the left ventricular ejection fraction (LVEF), plasma brain natriuretic peptide (BNP), and 6 min walking distance in the observation group were (52.45±6.02) %, (50.91±4.23) pg/mL, (422.07±20.59) m, respectively, which were better than those in the control group [(47.62±5.22) %, (68.77±6.81) pg/mL, (391.41±19.45) m, all P < 0.05]. Conclusion The continuous improvement in the construction of chest-pain centre can shorten the rescue time of STEMI patients, reduce the occurrence of cardiovascular adverse events, and improve the prognosis of patients, which is worthy of clinical application.
- Continuous improvement in chest-pain centre construction /
- Acute ST segment elevation myocardial infarction /
- Time of rescue /
- Adverse cardiovascular events

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图 1 胸痛中心建设持续改进后患者救治流程图

Figure 1. Chest pain center construction after continuous improvement of patient treatment flow chart

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表 1 2组ST段抬高型急性心肌梗死患者一般资料比较

Table 1. Comparison of general data between two groups of patients with ST-segment elevation acute myocardial infarction

组别	例数	性别(例)		年龄(x±s，岁)	脑血管病史(例)		合并心律失常(例)		梗死部位(例)
组别	例数	男性	女性	年龄(x±s，岁)	是	否	是	否	右室	多室壁	前壁	下壁
对照组	93	50	43	61.31±12.53	11	82	8	85	35	10	17	31
观察组	93	52	41	61.72±11.95	13	80	6	87	34	13	18	28
统计量		0.087^a		0.228^b	0.191^a		0.309^a		0.587^a
P值		0.768		0.820	0.662		0.578		0.899
注：^a为χ²值，^b为t值。

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表 2 2组ST段抬高型急性心肌梗死患者救治时间比较(x±s, min)

Table 2. Comparison of treatment time between two groups of ST-segment elevation acute myocardial infarction patients (x±s, min)

组别	例数	FMC-to-ECG	FMC-to-双抗	导管室激活	FMC-to-W	D-to-W
对照组	93	8.23±1.16	22.25±4.16	18.53±3.46	140.64±22.38	85.33±8.16
观察组	93	4.15±0.78	19.77±3.37	10.17±2.65	119.48±18.66	65.53±7.43
t值		28.147	4.467	18.499	7.003	17.302
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 2组ST段抬高型急性心肌梗死患者主要心血管不良事件发生率[例(%)]

Table 3. Incidence of major cardiovascular adverse events in patients with ST-segment elevation acute myocardial infarction in 2 groups [cases (%)]

组别	例数	心源性休克	心绞痛	心肌缺血	心力衰竭	心律失常	总发生
对照组	93	1(1.1)	3(3.2)	4(4.3)	3(3.2)	4(4.3)	15(16.1)
观察组	93	0	1(1.1)	1(1.1)	2(2.2)	2(2.2)	6(6.6)
注：2组心血管不良事件总发生率比较，χ²=4.348，P=0.037。

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表 4 2组ST段抬高型急性心肌梗死患者心功能比较(x±s)

Table 4. Comparison of cardiac function between two groups of ST-segment elevation acute myocardial infarction patients

组别	例数	LVEF(%)		BNP(pg/mL)		6 min步行距离(m)
组别	例数	出院时	出院后1个月	出院时	出院后1个月	6 min步行距离(m)
对照组	93	44.11±4.31	47.62±5.22^a	167.55±15.48	68.77±6.81^a	391.41±19.45
观察组	93	44.20±3.97	52.45±6.02^a	167.35±16.70	50.91±4.23^a	422.07±20.59
t值		0.148	5.846	0.085	21.484	10.439
P值		0.883	＜0.001	0.932	＜0.001	＜0.001
注：与同组出院时比较，^aP＜0.05。

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