作者：成联超1 ，陈应忠 2 ，叶滔 2 ，张翠 1 ，童兰 1 ，王燕凤 1 ，蔡琳 1，2

单位：

1.610031 四川省成都市，西南交通大学临床医学院　；2.610031 四川省成都市，西南交通大学附属成都市第三人民医院心内科；通信作者：蔡琳，E-mail：cailinwm@163.com

Units：

1.Clinical Medicine College of Southwest Jiaotong University，Chengdu 610031，China；2.Department of Cardiology，the Third People's Hospital of Chengdu，Affiliated to Southwest Jiaotong University，Chengdu610031，China；Corresponding author：CAI Lin，E-mail：cailinwm@163.com

关键词：

心肌梗死；区域协同救治体系；胸痛中心；转运；经皮冠状动脉介入治疗

Keywords：

Myocardial infarction；Regional Synergistic Treatment System；Chest pain center；Transport；Percutaneous coronary intervention

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.018

Funds：

基金项目：国家自然科学基金青年科学基金项目（81800239）；四川省科技计划项目应用基础研究（2018JY0126）

摘要：

目的　分析区域协同救治体系在 ST 段抬高型心肌梗死（STEMI）患者行转运急诊经皮冠状动脉介入治疗（PCI）中的作用。方法　选取 2017 年 1 月—2019 年 6 月成都地区 8 家具备 PCI 能力并建立“胸痛中心”的三级综合医院收治的行转运急诊 PCI 的 STEMI 患者 347 例。2018 年上述 8 家医院完成区域协同救治体系建立工作，并根据入院时间将所有患者分为 A 组 173 例（2017 年 1 月—2018 年 6 月）和 B 组 174 例（2018 年 7 月—2019 年 6 月）。比较两组患者关键救治时间节点〔包括发病至首次医疗接触（SO-to-FMC）时间、首次医疗接触至到达 PCI 医院大门（FMC-to-D）时间、到达 PCI 医院大门至首次球囊扩张（D-to-B）时间、首次医疗接触至首次球囊扩张（FMC-to-B）时间、发病至首次球囊扩张（SO-to-B）时间及 SO-to-FMC 时间、FMC-to-B 时间、D-to-B 时间达标率〕、救治效果（包括院内死亡及 PCI 后心功能指标）、住院费用及住院时间；STEMI 患者院内死亡及 PCI 后 LVEF<50%、局部室壁运动障碍影响因素的分析均采用多因素 Logistic 回归分析。结果　（1）两组患者 SO-to-FMC 时间、FMC-to-D 时间及 SO-to-FMC 时间达标率比较，差异无统计学意义（P>0.05）；B 组患者 D-to-B 时间、FMC-to-B 时间、SO-to-B 时间短于A 组，D-to-B 时间、FMC-to-B 时间达标率高于 A 组（P<0.05）。（2）两组患者 PCI 后室壁瘤发生率、住院费用及住院时间比较，差异无统计学意义（P>0.05）；B 组患者院内病死率及 PCI 后 LVEF<50% 者所占比例、局部室壁运动障碍发生率低于 A 组（P<0.05）。（3）多因素 Logistic 回归分析结果显示，B 组患者院内死亡、PCI 后 LVEF<50%、PCI后局部室壁运动障碍发生风险分别是A组患者的0.241倍〔95%CI （0.063，0.925）〕、0.368倍〔95%CI （0.173，0.784）〕、0.509 倍〔95%CI（0.287，0.901）〕（P<0.05）。结论　区域协同救治体系有利于缩短行转运急诊 PCI STEMI 患者的D-to-B 时间、FMC-to-B 时间、SO-to-B 时间，降低院内病死率，改善 PCI 后心功能，但对减少 SO-to-FMC 时间延误无明显效果。

Abstract：

Objective　To analyze the effect of Regional Synergistic Treatment System on STEMI patients transferredto perform emergency percutaneous coronary intervention（PCI）. Methods　From January 2017 to June 2019，a total of 347STEMI patients who were transferred to emergency PCI from 8 tertiary general hospitals with PCI ability and established "ChestPain Center" were selected in Chengdu. The above 8 hospitals completed the establishment of Regional Synergistic TreatmentSystem in 2018，and all of the 347 patients were divided into A group（admitted to hospital from January 2017 to June 2018，n=173）and B group（admitted to hospital from July 2018 to June 2019，n=174）according to the time of admission. Criticaltreatment time nodes（including SO-to-FMC time，FMC-to-D time，D-to-B time，FMC-to-B time，SO-to-B time，goodcontrol rate of SO-to-FMC time，FMC-to-B time and D-to-B time），treatment effect（including death during hospitalizationand index of cardiac function after PCI），hospitalization cost and hospital stays were compared between the two groups；influencing factors death during hospitalization，LVEF<50% and regional wall motion abnormalities after PCI in patients withSTEMI were analyzed by multivariate Logistic regression analysis. Results　（1）There was no statistically significant differencein SO-to-FMC time，FMC-to-D time or good control rate of SO-to-FMC time between the two groups（P>0.05）；D-to-Btime，FMC-to-B time and SO-to-B time in B group were statistically significantly shorter than those in A group，while goodcontrol rate of D-to-B time and FMC-to-B time in B group were statistically significantly higher than those in A group（P<0.05）.（2）There was no statistically significant difference in incidence of ventricular aneurysm after PCI，hospitalization cost orhospital stays between the two groups（P>0.05）；hospital fatality rate，proportion of patients with LVEF<50% after PCI andincidence of regional wall motion abnormalities in B group were statistically significantly lower than those in A group（P<0.05）.（3）Multivariate Logistic regression analysis results showed that，risk of death during hospital，LVEF<50% and regional wallmotion abnormalities after PCI in B group was 0.241 times〔95%CI（0.063，0.925）〕，0.368 times〔95%CI（0.173，0.784）〕and 0.509 times〔95%CI（0.287，0.901）〕than that in A group，respectively（P<0.05）. Conclusion　In STEMI patientstransferred to perform emergency PCI，Regional Synergistic Treatment System is helpful to shorten the D-to-B time，FMC-to-Btime，SO-to-B time，reduce the hospital fatality rate and improve the cardiac function after PCI，but it has no significant effecton SO-to-FMC time delay.

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