胸痛中心建设对行PCI术STEMI患者再灌注时间及预后的影响分析

刘淑军 吴春发 罗雅娟

摘 要 目的：分析胸痛中心建設对行经皮冠状动脉介入（PCI）术急性ST段抬高性心肌梗死（STEMI）患者再灌注时间及预后的影响。方法：回顾性分析江西省新余钢铁集团有限公司中心医院收治的行PCI术STEMI患者187例，其中2018年6月—2018年12月未建立胸痛中心收治的95例作为对照组，2019年1月—2019年6月建立胸痛中心后收治的92例作为观察组。观察并对比两组患者再灌注时间[从发生胸痛到球囊扩张（symptom onset to balloon，S-to-B）时间、首次医疗接触到球囊扩张（first medical contact to balloon，FMC-to-B）时间以及进入医院大门到球囊扩张（door to balloon，D-to-B）时间]、心脏不良事件发生率，并随访6个月后生活质量。结果：观察组的FMC-to-B以及D-to-B时间均短于对照组（P<0.05）；观察组心脏不良事件发生率为3.27%，低于对照组的10.53%（P<0.05）；随访6个月后，观察组生活质量核心问卷（QLQC-30）量表中的躯体、社会、角色、情绪以及认知功能的评分均较对照组高（P<0.05）。结论：胸痛中心建设可有效缩短PCI术STEMI患者FMC-to-B以及S-to-B时间，降低心脏不良事件发生率，有助于促进院外生活质量提高，改善预后。

关键词 急性ST段抬高性心肌梗死；PCI术；胸痛中心；再灌注时间；预后

中图分类号：R54 文献标志码：A 文章编号：1006-1533（2021）04-0023-03

Analysis of the impact of the construction of the chest pain center on the reperfusion time and prognosis of STEMI patients undergoing PCI

LIU Shujun， WU Chunfa， LUO Yajuan

（Emergency Department of Central Hospital of Xinyu Iron and Steel Group Co.， Ltd， Jiangxi 338000， China）

ABSTRACT Objective： To analyze the effect of the construction of the chest pain center on reperfusion time and prognosis of patients with acute ST segment elevation myocardial infarction（STEMI） undergoing percutaneous coronary intervention（PCI）. Methods： With the retrospective analysis 187 STEMI patients undergoing PCI surgery admitted to the Central Hospital of Xinyu Iron and Steel Group Co.， Ltd. in Jiangxi were collected， among them， 95 patients were selected as the control group from June 2018 to December 2018 when the chest pain center had not been established， and 92 patients admitted after the establishment of the chest pain center from January 2019 to June 2019 were selected as the observation group. The reperfusion time between the two groups of patients[from chest pain to balloon expansion（symptom onset to balloon， S-to-B）， first medical contact to balloon（FMC-to-B） ） time and the time from entering the hospital door to the door to balloon（D-to-B）]， the incidence of adverse cardiac events， and the quality of life after 6 months of follow-up were observed and compared. Results： The times of FMC-to-B and D-to-B in the observation group were shorter than those in the control group（P<0.05）； the incidence of adverse cardiac events was 3.27% in the observation group ， which was lower than that 10.53% in the control group（P<0.05）； after 6 months of follow-up， the scores of body， society， role， emotion and cognitive function in the observation group were higher than those in the control group（P<0.05）. Conclusion： The construction of the chest pain center can effectively shorten the FMC-to-B and S-to-B time of STEMI patients undergoing PCI， and reduce the incidence of adverse cardiac events that is helpful to improve the quality of life outside the hospital and improve the prognosis.

KEY WORDS acute ST segment elevation myocardial infarction； percutaneous coronary intervention； chest pain center； reperfusion time； prognosis

急性ST段抬高性心肌梗死（STEMI）的病發原因是冠状动脉因各种因素导致血管完全闭塞，从而引起一系列临床症状，是较为常见的具有致死性特点的急性胸痛性疾病[1-2]。主要表现为20 min以上的胸痛，血肌、心肌坏死标记物浓度升高，心电图ST段抬高[3]。目前，临床治疗多是在发病早期将梗死血管进行再灌注，再灌注治疗包括溶栓和经皮冠状动脉介入（PCI）术。PCI术为首选治疗方式，可有效降低死亡率，改善预后。但在救治过程中，常会因各种原因延误治疗时机，使得STEMI患者的再灌注时间达不到美国心脏病学会（ACC）/美国心脏协会（AHA）的指南标准，影响治疗效果[4]。建立一个可以提高STEMI患者治疗效率的方案对提升STEMI患者抢救率、改善预后有重要作用。……