摘要目的 探讨区域协同救治体系建设对ST段抬高型心肌梗死(STEMI)患者救治时间及近期预后的影响.方法 回顾性分析2013年1月至2017年1月上海交通大学医学院附属苏州九龙医院急诊科救治的急诊行直接经皮冠状动脉介入治疗(PPCI)的STEMI患者病例资料.以急性胸痛区域协同救治体系建立前的2013年1月至2014年12月就诊的患者作为A组;以救治体系建立后的2015年1月至2017年1月就诊的患者作为B组.记录患者发病-球囊扩张(S2B)时间、首次医疗接触-球囊扩张(FMC2B)时间、入门-球囊扩张(D2B)时间,以及90 d终点事件(包括心力衰竭、全因死亡及其他相关不良事件)发生情况.采用多因素Logistic回归分析区域协同救治体系建立与90 d终点事件发生率的关系.结果 入选221例STEMI患者,A组83例,B组138例.与A组比较,B组S2B时间、FMC2B时间和D2B时间均明显缩短〔S2B时间(min):180(140,210)比201(154,225),FMC2B时间(min):89(78,100)比94(83,107),D2B时间(min):66(62,70)比85(72,99),均P<0.05〕,90 d终点事件发生率明显降低(心力衰竭:20.3％比32.5％,全因死亡:1.4％比7.2％,其他相关不良事件:23.2％比36.1％,均P<0.05).多因素Logistic回归分析显示,区域协同救治体系建立可以减少90 d终点事件的发生率 〔心力衰竭:优势比(OR)=1.904,95％可信区间(95％CI)=0.968～1.004,P=0.048;全因死亡:OR=11.724,95％CI=0.955～1.048,P=0.013;其他相关不良事件:OR=1.925,95％CI=1.049～3.530,P=0.034〕.结论 区域协同救治体系建设能有效缩短STEMI患者的急诊救治时间,减少90 d心力衰竭、死亡等不良事件的发生.

abstractsObjective To explore the effect of regional synergistic treatment system on the treatment time and short-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI).Methods A retrospective analysis of the clinical data of STEMI patients who admitted to emergency center of Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine and underwent primary percutaneous coronary intervention (PPCI) from January 2013 to January 2017 were conducted. All patients were divided into two groups, group A was the patients who underwent the PPCI before the establishment of the acute chest pain area co-treatment system (from January 2013 to December 2014), and group B was the patients who received the treatment after the establishment of the area co-treatment system (from January 2015 to January 2017). The length of time from onset of symptoms to the balloon dilatation (S2B), the length of time from the first medical contact to the balloon dilatation (FMC2B), the length of time from entering the gate of hospital to the balloon dilatation (D2B), and the incidence of 90-day end point events (including heart failure, all-cause death, and other related adverse events) were collected. The relations of the establishment of the acute chest pain area co-treatment system and the incidence of 90-day end point events were analyzed by multivariable Logistic regression analysis.Results Among the 221 enrolled patients with STEMI, 83 patients were in group A and 138 patients were in group B respectively. Compared with group A, S2B time [minutes: 180 (140, 210) vs. 201 (154, 225)], FMC2B time [minutes: 89 (78, 100) vs. 94 (83, 107)] and D2B time [minutes: 66 (62, 70) vs. 85 (72, 99)] were significantly shortened in group B (allP < 0.05), the incidence of 90-day end point events were significantly decreased (heart failure:20.3％ vs. 32.5％, all-cause death: 1.4％ vs. 7.2％, other related adverse events: 23.2％ vs. 36.1％, allP < 0.05). It was shown by multivariable Logistic regression analysis that the establishment of the acute chest pain area co-treatment system could lower the incidence of 90-day end point events [heart failure: odds ratio (OR) = 1.904, 95％ confidence interval (95％CI) = 0.968-1.004, P = 0.048; all-cause death:OR = 11.724, 95％CI = 0.955-1.048,P = 0.013; other related adverse events:OR = 1.925, 95％CI = 1.049-3.530,P = 0.034].Conclusion The construction of regional synergistic treatment system can shorten the emergency treatment time of STEMI patients and reduce the incidence of 90-day end point events including heart failure and death.