医疗支援模式对当地急性心肌梗死诊治及预后的影响

摘要

目的：：探讨医疗支援模式对当地急性心肌梗死诊治及预后的影响。方法：复旦大学附属中山医院2010年3月起对云南省曲靖市富源县人民医院进行医疗对口支援活动,选择2010年3月—2014年4月富源县人民医院收治的103例急性心肌梗死患者,将2010年3月—2012年11月收治的51例患者分为 A 组,2012年12月—2014年4月收治的52例患者分为 B 组。对2个时间段内患者的治疗策略、住院天数、用药情况及预后进行比较。结果：103例急性心肌梗死患者中,男性吸烟比例显著高于女性(P <0.05)。只有21例 ST 段抬高型急性心肌梗死患者在发病12 h 之内就诊。B 组 ST 段抬高型急性心肌梗死患者溶栓率高于 A 组(P <0.05)。57例患者获得随访,其中只有约1/3的患者接受了后续的冠脉造影和 PCI 术。B 组住院期间二磷酸腺苷(ADP)受体拮抗剂(氯吡格雷)的使用率高于 A 组(P <0.05)。出院后 ADP 受体拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、氯吡格雷等药物的使用率均明显下降,但2组差异无统计学意义。2组各终点事件发生率差异均无统计学意义(P >0.05)。结论：医疗支援模式提高了住院期间心肌梗死的诊断率和治疗规范性。但住院前的就诊时间仍没有缩短,出院后二级预防治疗不规范,说明除了加强住院期间的医疗诊治能力外,仍需加大对患者的健康教育和基层医护人员的培训,并加强区域合作。%Objective:To explore the effects of medical support program on local diagnosis,treatment and prognosis of acute myocardial infarction(AMI).Methods:Department of Cardiology,Zhongshan Hospital,Fudan University launched medical support program for Fuyuan People′s Hospital in Mar 2010.A total of 103 AMI patients admitted to Fuyuan People′s Hospital during Mar 2010 and Apr 2014 were enrolled.And 5 1 patients admitted during Mar 2010 and Nov 2012 were allocated to group A,while 52 patients admitted during Dec 2012 and Apr 2014 were allocated to group B.The treatment strategy,hospital stay, medication and prognosis were compared between the two groups.Results:Among the 103 AMI patients,male smoking pro-portion was significantly higher than female one(P <0.05).Only 21 patients with ST segment elevation myocardial infarction (STEMI)arrived hospital within 12 h.The thrombolytic therapy rate of patients with STEMI in group B was higher than that in group A(P <0.05).The usage rate of adenosine diphosphate(ADP)receptor antagonist(clopidegrel)during hospitalization in group B was higher than that in group A (P <0.05 ).Only 57 patients were followed up.And only 1/3 of these patients re-ceived consecutive coronary angiography and percutaneous coronary intervention(PCI).After discharge from hospital,the pre-scription rates of ADP receptor antagonist,β-receptor blockers and angiotension converting enzyme inhibitor (ACEI)all de-creased obviously and there was no significant difference between the two groups(P >0.05).There was no significant difference regarding the incidence rates of endpoint events between the two groups(P >0.05).Conclusions:Medical support program im-proves the rates of diagnosis and standardized treatment of AMI during hospitalization.However,the delay before admission has not been shortened yet.Furthermore,there was no standardized secondary prevention and treatment after discharge.Thus,apart from improving the ability of diagnosis and treatment during hospitalization,more attention should be paid to the health education for patients and the training for primary medical staff,and enhance the regional cooperation.