胸痛中心处理急性胸痛患者的临床对照研究

摘要

目的 分析胸痛中心在处理急性胸痛患者中的有效性和安全性.方法 回顾性分析2012年1月至2016年12月在成都中医药大学附属医院就诊的315例急性胸痛患者的临床资料,将2014年12月前非胸痛中心处理的123例急性胸痛患者设为对照组,2014年12月至2016年12月由胸痛中心处理的192例患者设为观察组,比较两组患者急性心肌梗死确诊率、接受急诊经皮冠状动脉介入治疗(PCI)率、门-球(D to B)时间、住院时间及主要不良心血管事件的发生情况.结果 观察组对胸痛患者急性心肌梗死确诊率显著大于对照组(82.3％比75.6％,P=0.027),差异有统计学意义.确诊的急性心肌梗死患者中,观察组患者接受急诊PCI比例显著大于对照组(92.4％比83.9％,P=0.001),而住院时间显著小于对照组[(7.41±3.78)d比(10.09±4.03)d,P=0.025];接受急诊PCI的患者中,观察组D to B时间显著小于对照组[(58.08±16.26)min比(64.12±34.76)min,P=0.025].急性心肌梗死患者住院期间,观察组患者主要不良心血管事件发生率显著低于对照组(47.5％比50.5％,P=0.027),其中观察组患者心源性猝死(5.7％比6.5％,P=0.041)、心力衰竭(31.6％比33.3％,P=0.019)比例显著低于对照组,而两组间心源性休克、再发心肌梗死比例比较,差异均无统计学意义(均P＞0.05).结论 胸痛中心处理急性胸痛患者更加安全有效.%Objective To analyze the effectiveness and safety of chest pain centers in the management of patients with acute chest pain.Methods The clinical data of 315 patients with acute chest pain who presented to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2012 to December 2016 were retrospectively analyzed.The chest pain center of our hospital was established in December 2014.A total of 123 patients with acute chest pain who were treated before the establishment of the chest pain were included as the control group.From December 2014 to December 2016,192 patients with chest pain were admitted and included as the observation group.The percentages of acute myocardial infarction and patients receiving emergency intervention(percutaneous coronary intervention,PCI),the door-to-balloon(D to B)time,average length of hospital stay and rates adverse events between the two groups were compared.Results The percentages of acute myocardial infarction among patients with acute chest pain was 75.6％in the control group and 82.3％in the observation group(P=0.027).The emergency PCI rate was 83.9％in the control group and 92.4％in the observation group(P=0.001).The door-to-balloon time was(64.12±34.76)min in the control group and(58.08±16.26)min in the observation group(P=0.025).The average length of hospital stay was(10.09±4.03)days for the control group,and(7.41±3.78)days for the observation group(P=0.025).There was no statistical difference in the incidence of recurrent myocardial infarction between the 2 groups(P＞0.05).The rates of sudden cardiac death,heart failure,cardiogenic shock and adverse events were all significantly higher in the control group(all P＜0.05).Conclusions The establishment of chest pain center provides safer and more effective treatment to patients with acute chest pain.