优化直接经皮冠状动脉介入治疗流程对ST段心肌梗死患者预后的影响

摘要

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(D to B)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:D to B时间;门-心电图(D to E)时间;心电图-导管室(Eto L)时间;导管室-球囊(L to B)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D toB时间为(91.3±14.0)min比(103.3±14.1)min(t=4.72,P<0.01).D to B时间的缩短主要得益于E to L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(X2=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D to B时间,使CK-MB,cTnl峰值明显降低.%Objective To identify the impact of optimization of ST-segment elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PPCI) protoeal on door-to-balloon (D to B) time and impacet on prognosis.Methods We retrospectively analyzed 124 consecutive patients with STEMI undergone PPCI from January 2009 to June 2010 in Zhejiang Taizhou Hospital.Patients were divided into two groups according to the lab activation mode.In group A ( n = 54), the catheterization laboratory was activated by cardiologist after specialists consultation and confirmed digonosis by ECG and in group B (n =70) the catheterization laboratory was activated by physicians in the emergency room.Primary end pionts included D to B time, door-to- electrocardiogram (D to E) time, electrocardiogram-to- laboratory (E to L)time and laboratory-to-balloon (L to B ) time.Secondary end points included peak of creatine kinase-MB (CK-MB) and Troponin Ⅰ (TnI), total mortality and major adverse cardiac event (MACE) in hospital and after 30 days of follow-up.Results Baseline characteristics were similar between the two groups.D to B time in group B were significantly shorter than those in group A (91.3 ± 14.0 min vs.103.3 ± 14.1 min, P ＜0.01 ) , which was gained mainly by the shorter of E to L time (65.4 ± 14.5 min vs.75.9 ± 14.5 min, P ＜0.01 ).Peak levels of CK-MB and TnI in group B were significantly lower than those in group A (257 ±205 U/L vs.392 ± 292 U/L, P ＜ 0.01; 43.4 ± 29.5 ng/ml vs.56.3 ± 32.3 ng/ml, P ＜ 0.05 ).Total mortality and MACE in hospital and after 30 days of follow-up were similar between the two groups.Conclusions Catheterization laboratory was activated by emergency medicine physician directly could markedly reduce D to B time and decrease the peak of CK-MB and TnI in patients with STEMI.