作者：张旭霞，王树东，王锐，廉银珠，林希

单位：

134002 吉林省通化市中心医院心内科；通信作者：王树东，E-mail：wangsd1129@163.com

Units：

Department of Cardiology，the Central Hospital of Tonghua，Tonghua 134002，China；Corresponding author：WANG Shudong，E-mail：wangsd1129@163.com

关键词：

心肌梗死；区域协同救治体系；转诊；再灌注治疗；预后

Keywords：

Myocardial infarction；Regional Synergistic Treatment System；Referral；Reperfusion treatment；Prognosis

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.019

Funds：

摘要：

目的　探讨区域性协同救治体系下转诊对 ST 段抬高型心肌梗死（STEIM）患者再灌注治疗时间及短期预后的影响。方法　选取 2016 年 9 月—2018 年 1 月首诊于非经皮冠状动脉介入治疗（PCI）医院并转诊至通化市中心医院胸痛中心行急诊 PCI 的 STEMI 患者 200 例，根据转诊方式不同分为常规转诊 92 例（A 组）和区域协同救治体系下转诊 108 例（B 组）。比较两组患者再灌注治疗时间〔包括首次医疗接触至首次球囊扩张（FMC-to-B）时间、到达 PCI 医院大门至首次球囊扩张（D-to-B）时间、FMC-to-B 时间达标率、D-to-B 时间达标率〕、住院期间病死率、住院时间及住院费用；术后随访 6 个月，比较两组患者主要不良心血管事件（MACE）发生率。结果　（1）B 组患者FMC-to-B 时间、D-to-B 时间及住院时间短于 A 组，FMC-to-B 时间达标率、D-to-B 时间达标率高于 A 组，住院期间病死率、住院费用低于A组（P<0.05）。（2）随访期间A组患者MACE发生率为10.9%，高于B组患者的3.7%（P<0.05）。结论　区域性协同救治体系下转诊可有效缩短 STEMI 患者再灌注治疗时间及住院时间，降低患者住院期间病死率及住院费用，改善患者短期预后。

Abstract：

Objective　To investigate the impact of referral under Regional Synergistic Treatment System on time toreperfusion therapy and short-term prognosis in patients with STEMI. Methods　From September 2016 to January 2018，a totalof 200 STEMI patients underwent emergency PCI were selected in the Chest Pain Center，the Central Hospital of Tonghua，allof them were first diagnosed and transferred from non-PCI hospital，and they were divided into A group（with routine referral，n=92）and B group（with referral under Regional Synergistic Treatment System，n=108）according to the referral mode. Timeto reperfusion therapy（including FMC-to-B time，D-to-B time，good control rate of FMC-to-B time and D-to-B time），fatality rate during hospitalization，hospital stays and hospitalization cost were compared between the two groups，moreoverincidence of postoperative major adverse cardiovascular events（MACE）was compared during the 6-month follow-up. Results　（1）FMC-to-B time，D-to-B time and hospital stays in B group were statistically significantly shorter than those in Agroup，good control rate of FMC-to-B time and D-to-B time in B group were statistically significantly higher than those in Agroup，while fatality rate during hospitalization and hospitalization cost in B group were statistically significantly lower than thosein A group（P<0.05）.（2）Incidence of postoperative incidence of MACE in A group was 10.9% during the 6-month follow-up，which is statistically significantly higher than that in B group of 3.7%（P<0.05）. Conclusion　In patients with STEMI，referral under Regional Synergistic Treatment System can effectively shorten the time to reperfusion therapy and hospital stays，reduce the fatality rate during hospitalization and hospitalization cost，improve the short-term prognosis.

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