薛迎生,江建军,章晨,王斌,方崇峰,唐礼江

• 1:浙江省临海市台州医院心内科

摘要(Abstract)：

目的探讨优化直接经皮冠状动脉介入治疗(PPCI)流程对门-球囊时间(DtoB)及ST段抬高心肌梗死(STEMI)患者预后的影响。方法回顾性分析2009年1月—2010年6月在台州医院心内科成功行PPCI的STEMI患者的临床资料。按不同导管室启动模式分为A组和B组。A组:急救中心医生初步诊断STEMI后通知心内科医生会诊,后者确认后再通过导管室负责人启动导管室;B组:急救中心医生初步诊断STEMI后直接通知导管室负责人,后者派心内科医生会诊的同时启动导管室。主要分析指标为PPCI相关时间:DtoB时间;门-心电图(DtoE)时间;心电图-导管室(EtoL)时间;导管室-球囊(LtoB)时间。次要分析指标为临床结果 :肌酸激酶同工酶MB(CK-MB)、肌钙蛋白I(TnI)峰值;住院期间及出院后30天累计死亡率,主要不良心脏事件(MACE)发生率。结果两组共入选患者124例,A组54例,B组70例,两组患者基础临床情况相近。B组与A组比较DtoB时间为(91.3±14.0)min比(103.3±14.1)min(t=4.72,P<0.01)。DtoB时间的缩短主要得益于EtoL时间的缩短(65.4±14.5)min比(75.9±14.5)min(t=4.01,P<0.01);B组CK-MB、cTnI峰值较A组均有明显降低,分别为(257±205)U/L比(392±292)U/L(t=2.90,P<0.01)、(43.4±29.5)比(56.3±32.3)ng/ml(t=2.31,P<0.01)。两组住院期间及出院后30天总死亡率、MACE发生率差异无统计学意义(χ2=1.66、0.01、0.57、0.06,P>0.05)。结论急救中心医生直接通过导管室负责人预先启动导管室较传统呼叫心内科医生会诊后启动导管室能明显缩短DtoB时间,使CK-MB、cTnI峰值明显降低。

关键词(KeyWords)： 心肌梗死;门-球囊时间;血管成形术,经腔,经皮冠状动脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 薛迎生,江建军,章晨,王斌,方崇峰,唐礼江

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