急诊PCI介入时间延迟对AMI患者预后的影响及延迟因素分析

摘要

目的 分析急诊经皮冠状动脉介入(PCI)治疗时间延迟对急性心肌梗死(AMI)患者预后的影响及延迟相关因素.方法 回顾性分析医院2015年9月～2017年5月收治的急诊PCI患者的临床资料,以建立CPC时间节点(2016年7月)暴露分组,将2016年7月及以前收治的89例纳入A组,将2016年8月及以后收治的144例纳入B组,对比两组近远期预后差异、急诊流程时间[包括发病-首次医疗接触时间(S0-to-FMC)、入门-导管室时间(D-to-C)、进门至球囊扩张时间(D-to-B)].结果 B组PCI术后左室射血分值(LVEF)高于A组,左心室舒张末期内径(LVEDd)低于A组,住院时间及费用低于A组,不良心血管事件(MACE)、出血性并发症及机械性并发症等总发生率(2.78％)亦显著低于A组(12.36％)(P＜0.05).结论 急诊PCI术介入时间延迟不利于AMI患者预后,通过建立胸痛中心可缩短院外急诊流程时间,减少D-to-B时间,改善患者预后,且可降低医疗费用.%Objective To analyze the impacts of time delay of emergency PCI on prognosis of AMI patients and the influencing factors of time delay.Methods A retrospective analysis was conducted on clinical results of emergency PCI patients admitted into our hospital from September 2015 to May 2017.The patients were grouped according to the visiting time (July 2016):those admitted during or before July 2016 were in Group A (n=89) while those admitted during or after August 2016 were in Group B (n=144).The near-term and long-term prognoses,emergency procedure duration (including onset of disease-first medical contact (SO-to-FMC),door-to-cath lab (D-to-C) and door-to-balloon dilatation (D-to-B)) were compared between the two groups.Results Group B had a higher left ventricular ejection fraction (LVEF) than Group A after PCI and lower left ventricular end-diastolic dimension(LVEDd) than Group A.The hospital stays and expenditures of Group B were also lower.The total incidences of major adverse cardiac events (MACE),hemorrhagic complications and mechanical complications (2.78％) were significantly lower than those of Group A(12.36％) (P ＜0.05).Conclusion Time delay of emergency PCI is unfavorable for prognosis of AMI patients.The time for outpatient emergency procedure and the D-to-B step can be shortened by setting up a chest pain center so as to improve patients' prognosis and reduce hospitalization costs.