目的了解河北省二、三级医院急性ST段抬高型心肌梗死(STEMI)患者早期再灌注治疗现状及预后情况。方法收集河北省二、三级医院经急诊就诊的急性心肌梗死(AMI)患者资料,入选发病12 h内的2010例STEMI患者,分析基线资料、治疗现状及预后情况。结果二、三级医院接受早期再灌注治疗比例占总人数的69.1%,其中接受直接经皮冠状动脉介入治疗(PCI)的患者占53.0%,接受溶栓治疗的患者占16.1%;未行早期再灌注治疗的患者占30.9%。二、三级医院早期再灌注治疗的比例差异无统计学意义(68.8%vs.69.1%,P> 0.05),二级医院以溶栓治疗为主(62.0%vs.9.2%,P <0.001),直接PCI比例较低(6.8%vs.60.0%,P <0.001)。与三级医院比较,二级医院未接受再灌注治疗的原因中存在溶栓禁忌、医院不具备PCI条件比例较高(56.1%vs.10.2%,31.7%vs.2.2%,P均<0.001)。二级医院与三级医院的STEMI患者住院病死率差异无统计学意义(7.6%vs.5.4%,P> 0.05)。二级医院与三级医院三年内随访生存率差异均无统计学意义(94.5%vs.93.1%,90.7%vs.90.6%,87.4%vs.88.5%,P均> 0.05)。二级医院因心源性休克所致死亡比例较三级医院高(5.3%vs.2.5%,P <0.05)。结论河北省二、三级医院急性STEMI患者的再灌注治疗方式仍存在巨大区域差异;与以直接PCI为主的再灌注方式比较,以溶栓为主的再灌注方式具有相同的预后;仍有相当比例的患者未早期接受任何再灌注治疗。Objective To investigate the early reperfusion treatment and prognosis of acute ST-segment elevation myocardial infarction( STEMI) patients in secondary and tertiary hospitals in Hebei province. Methods Data of acute myocardial infarction( AMI) patients treated in the emergency department of secondary and tertiary hospitals in Hebei province were collected,and STEMI patients within 12 hours of onset were selected and their baseline data,treatment status and prognosis were analyzed. Results The proportion of patients receiving early reperfusion therapy accounted for 69. 1%of the total number of patients,among which 53. 0% received primary percutaneous coronary intervention( PCI) and 16. 1% received thrombolytic therapy. Patients without early reperfusion therapy accounted for 30. 9%. There was no statistically significant difference in the proportion of early reperfusion treatment in secondary hospitals and tertiary hospitals( 68. 8% vs. 69. 1%,P > 0. 05),while thrombolytic therapy was dominant in secondary hospitals( 62. 0% vs. 9. 2%,P < 0. 001),and the proportion of primary PCI was lower( 6. 8% vs. 60. 0%,P < 0. 001). Among the reasons for not receiving reperfusion treatment, the proportion of thrombolytic contraindications and PCI ability deficiency in secondary hospitals were higher than those in tertiary hospitals( 56. 1% vs. 10. 2%,31. 7% vs. 2. 2%,all P < 0. 001). There was no significant difference in in-hospital mortality( 5. 4%vs. 7. 6%,P > 0. 05) between the STEMI patients from the tertiary hospitals and secondary hospitals.There was no statistically significant difference in the survival rate between secondary hospitals and tertiary hospitals for 3-year follow-up( 94. 5% vs. 93. 1%,90. 7% vs. 90. 6%,87. 4% vs. 88. 5%,all P > 0. 05). The death rate of secondary hospitals caused by cardiogenic shock was higher than that of tertiary hospitals,and the difference was significant( 5. 3% vs. 2. 5%,P < 0. 05). Conclusion There are still huge regional differences in the reperfusion treatment of STEMI inpatients
机构地区河北医科大学第二医院急诊科
出处《中国急救医学》 CAS CSCD 北大核心 2021年第2期122-126,共5页Chinese Journal of Critical Care Medicine
基金河北省政府资助临床医学优秀人才培养和基础课题研究项目(2017-46)。
关键词急性ST段抬高型心肌梗死(STEMI) 心肌再灌注 溶栓 经皮冠状动脉介入(PCI) 医院级别ST-segment elevation myocardial infarction(STEMI) Myocardial reperfusion Thrombolysis Percutaneous coronary intervention(PCI) Hospital level
分类号R54 [医药卫生—心血管疾病]
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