Objective To study the clinical outcome and gap analysis of following treatmest algorithm for patients with acute coronary syndrome. Methods According to ACC/AHA and the Chinese acute coronary syndrome diagnosis and treatment guidelines, we defined a custom made acute coronary syndrome treatment algorithm for our hospital. Evaluation and audit for the execution of algorithm was carried out every 6 months. Inpatient ACS patients were chosen as research objects. We collected 194 patients with ACS between October 2006 - March 2008 as a baseline obsurvation,and after the initiation of algorithm, we collected another 175 patients with ACS between April 2008 - September 2009. Results After the execution of Clinical in algorithm in patients with acute myocardial infarction, patients with acute ST elevation myocardial infarction shortened the average length of hospital stay by 3. 5 days, patients with acute non-ST elevation myocardial infarction by 6. 14 days. The rate of high-risk patients who received coronary angiography was 66. 1 % , which was higher than the baseline level of 32. 9% ( P < 0. 05 ). Following the algorithm, for patients with acute ST elevation myocardial infarction, the door-to-balloon time was 195 minutes with decrease of 43. 4% , compared with baseline ( P < 0. 01 ) . Patients with the ST-elevation myocardial infarction who arrived the hospital within 12 hours with early reperfusion rates rised from baseline of 63. 6% , to 87. 3 % after the initiation of algorithm ( P < 0. 05 ) . For medical treatment of ACS, the prescription of ACEI/ARB and the ratio of quadruple therapy improved. The mortality rate decreased by 4. 1 % compared with baseline ( P < 0. 01 ) . Conclusions Standardized clinical algorithm reduced the hospitalization days for patients with acute myocardial infarction, decreased the D-B time, increased the proportion of acceptance of emergency PCI for STEMI patients and improved the survival rate of inpatients with ACS.%目的 通过优化和畅通急性冠脉综合征(ACS)患者的诊疗流程,缩小临床试验与循证医学的差距,持续改进诊疗质量,合理利用有限的医疗资源,使患者最大获益.方法 以宝鸡市中医医院心内科住院ACS患者为研究对象,收集干预前2006年10月至2008年3月194例ACS患者作为执行路径前病例,执行路径干预后连续收集2008年4月至2009年9月ACS病例175例.根据美国心脏病学学会/美国心脏协会(ACC/AHA)及中国急性冠状动脉综合征诊治指南制定我院ACS临床路径,将临床路径附在病例中,对诊治关键环节进行干预,每6个月对执行情况评估1次,分析数据,提出改进措施.结果 临床路径干预后急性心肌梗死(AMI)患者住院时间较干预前明显缩短,其中急性ST抬高心肌梗死(STEMI)患者平均住院天数降低了3.5d,急性非ST抬高心肌梗死(NSTEMI)患者平均住院时间降低6.14d,差异具有统计学意义(P＜0.05).干预后高危患者接受冠脉造影率为66.1％,较干预前的32.9％明显增高,差异具有统计学意义(P＜0.05).干预后STEMI患者入院到球囊扩张时间(D-B时间)较干预前下降了43.4％ (P ＜0.01).12 h内到达医院的STEMI患者中早期再灌注治疗率干预前后分别为63.6％和87.3％(P＜0.05).ACS药物规范治疗方面,干预后明显提高.干预后ACS患者住院死亡率下降4.1％(P＜0.05).结论 本研究通过临床路径的干预显著降低了AMI患者住院天数、缩短了D-B时间,提高了STEMI患者接受急诊PCI的比例,ACS住院患者死亡率明显下降.同时,使临床医生的医疗行为更接近指南的要求,使医疗资源的利用更加合理.对AMI干预的结果优干不稳定性心绞痛( UA).
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