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  • 赵英英,徐浩,胡国勇,高玮,沈兵.胸痛中心认证对急性ST段抬高型心肌梗死患者救治的影响[J].第二军医大学学报,2019,40(8):898-901    [点击复制]
  • ZHAO Ying-ying,XU Hao,HU Guo-yong,GAO Wei,SHEN Bing.Effects of chest pain center certification on the treatment of patients with acute ST-elevated myocardial infarction[J].Acad J Sec Mil Med Univ,2019,40(8):898-901   [点击复制]
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胸痛中心认证对急性ST段抬高型心肌梗死患者救治的影响
赵英英1,徐浩2,胡国勇3,高玮4,沈兵5*
0
(1. 上海交通大学附属第一人民医院急诊危重病科, 上海 200080;
2. 上海交通大学附属第一人民医院心内科, 上海 200080;
3. 上海交通大学附属第一人民医院消化科, 上海 200080;
4. 上海交通大学附属第一人民医院老年医学科, 上海 200080;
5. 上海交通大学附属第一人民医院泌尿外科, 上海 200080
*通信作者)
摘要:
目的 比较胸痛中心模式认证前与认证后急性ST段抬高型心肌梗死(STEMI)的救治情况,为胸痛中心的建设提供依据。方法 回顾分析上海交通大学附属第一人民医院胸痛中心认证前与认证后的急性STEMI患者救治数据,将2017年1月至2017年12月救治的119例患者纳入认证前组,2018年1月至2019年4月救治的160例患者纳入认证后组,比较两组患者基线资料、患者首次医疗接触到首份心电图时间、首份心电图确认时间、肌钙蛋白报告时间、导管室激活时间、入院到球囊扩张时间、住院时间、住院药品费、住院检查费、住院检验费、住院总费用、救治效果等的差异。结果 两组患者性别、年龄、高血压病史和糖尿病史等一般资料差异均无统计学意义(P均>0.05)。两组患者导管室激活时间差异无统计学意义(P>0.05);认证后组患者首次医疗接触到首份心电图时间(Z=-7.247,P<0.001)、首份心电图确认时间(Z=-5.072,P<0.001)、肌钙蛋白报告时间(Z=-3.210,P=0.001)、入院到球囊扩张时间(Z=-7.025,P<0.001)均短于认证前组,差异均有统计学意义。两组患者住院时间、住院药品费、住院检查费、住院检验费、住院总费用和死亡率等指标差异均无统计学意义(P均>0.05)。结论 通过胸痛中心模式认证和规范化运行可缩短急性STEMI患者救治时间。
关键词:  胸痛中心  急性ST段抬高型心肌梗死  入院到球囊扩张时间  经皮冠状动脉介入治疗
DOI:10.16781/j.0258-879x.2019.08.0898
投稿时间:2019-07-02修订日期:2019-08-06
基金项目:上海申康医院发展中心临床科技创新项目:医疗大数据的统一存储构建设计与推进精准医疗的意义探讨SHDC12017623
Effects of chest pain center certification on the treatment of patients with acute ST-elevated myocardial infarction
ZHAO Ying-ying1,XU Hao2,HU Guo-yong3,GAO Wei4,SHEN Bing5*
(1. Department of Emergency, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China;
2. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China;
3. Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China;
4. Department of Geriatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China;
5. Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
*Corresponding author)
Abstract:
Objective To compare the treatment of acute ST-elevated myocardial infarction (STEMI) before and after the certification of chest pain center model, so as to provide reference for the construction of chest pain center. Methods We retrospectively analyzed the clinical data of patients with acute STEMI before and after certification of the chest pain center of Shanghai General Hospital of Shanghai Jiao Tong University. Totally 119 patients were included in the pre-certification group from January 2017 to December 2017, and 160 patients were included in the post-certification group from January 2018 to April 2019. The baseline data, first medical contact to electrocardiogram (ECG) time, first ECG confirmation time, troponin reporting time, cath lab activation time, door-to-balloon dilation time, hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, and outcomes were compared between the two groups. Results There was no significant difference in the gender, age, history of hypertension or history of diabetes between the two groups (all P>0.05). The cath lab activation time was not significantly different between the two groups (P>0.05). The first medical contact to ECG time (Z=-7.247, P<0.001), first ECG confirmation time (Z=-5.072, P<0.001), troponin reporting time (Z=-3.210, P=0.001) and door-to-balloon dilation time (Z=-7.025, P<0.001) were significantly shorter in the post-certification group than those in the pre-certification group. There were no significant differences in hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, or mortality between the two groups (all P>0.05). Conclusion Through the certification and standardized operation of chest pain center, the time of treatment for acute STEMI can be significantly shortened.
Key words:  chest pain center  acute ST segment elevation myocardial infarction  door to balloon time  percutaneous coronary intervention