孔冉冉,易绍东,张金霞,顾晓龙,苏晞,李平,任洁,董少红,杨丽霞,肖纯,王斌,赵榆华,张小勇,兰军,杨敏,唐良秋,关紫云,冯力,陈纪言,向定成

• 1:中国人民解放军南部战区总医院心内科
• 2:武汉亚洲心脏病医院心内科
• 3:玉林市第一人民医院心内科
• 4:西安交通大学附属第一医院心内科

摘要(Abstract)：

目的 分析国内16家通过胸痛中心认证的三级甲等医院的数据，评价胸痛中心认证对行直接经皮冠状动脉介入治疗（PPCI）的急性ST段抬高型心肌梗死（STEMI）患者救治时间和近期预后的影响。方法 从胸痛中心数据库平台提取16家医院，从开始建立胸痛中心至2019年12月31日收治发病12h内且接受了PPCI的STEMI患者共计16449例，以各家医院通过胸痛中心认证的时间作为患者分组界限，将开始进行胸痛中心建设至通过认证前一天（建设期）收治的患者作为A组（4173例），通过胸痛中心认证后至2019年12月31日收治的患者为B组（12 276例），比较两组患者的救治时间、院内心力衰竭发生率和死亡率。结果 相比A组而言，B组患者发病至首次医疗接触（S-to-FMC）时间从120 min缩短至105 min[120(65,216)min比105(60,175)min,P <0.001]，首次医疗接触至导丝通过（FMC-to-W）时间从159min降至138min[159(113,246)min比138(84,211)min,P<0.001]，进门至导丝通过（D-to-W）时间从77min降至60min[77(55,100)min比60(45,79)min,P<0.001]，发病至导丝通过（总缺血）（S-to-W）时间从323min降至277min[323(233,465)min比277(190,388)min,P<0.001]。STEMI患者的院内心力衰竭发生率从建设期的18.6%下降至认证后的13.4%(P<0.001)，院内死亡率从建设期的3.6%下降至认证后的2.8%(P=0.010)。多因素Logistic回归分析显示，心力衰竭使STEMI患者死亡率增加15.8倍；S-to-W时间每延长1h,STEMI患者死亡率增加2.2倍。结论 胸痛中心认证工作显著缩短了接受PPCI的STEMI患者的救治时间，有效降低了STEMI患者的院内心力衰竭发生率及死亡率，未来应继续推动胸痛中心建设及认证。

关键词(KeyWords)： 胸痛中心;认证;急性ST段抬高型心肌梗死;院内死亡率;院内心力衰竭发生率

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2 0 16Y F C 13012 01）;; 国家自然科学基金面上项目（61571182）;; 广州市科技计划项目（202002020036）

作者(Author): 孔冉冉,易绍东,张金霞,顾晓龙,苏晞,李平,任洁,董少红,杨丽霞,肖纯,王斌,赵榆华,张小勇,兰军,杨敏,唐良秋,关紫云,冯力,陈纪言,向定成

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