首诊急性心肌梗死患者入门至球囊扩张时间对临床救治效果的影响(1)
[摘要] 目的 考察首诊急性心肌梗死患者入门至球囊扩张时间(D-to-B)对临床救治效果的影响。方法 选取2018年1月～2019年6月于我院胸痛中心收治的急性心肌梗死患者210例，均行经皮冠状动脉介入治疗(Percutaneous coronary intervention，PCI)，以D-to-B时间90 min为分界点，将纳入患者分为D-to-B≤90 min组(n=90)和D-to-B>90 min组(n=120)，比较两组患者的一般临床资料及主要不良心血管事件(Major adverse cardiac events，MACE)，并采用多因素Logistic回归模型分析AMI患者PCI术后的危险因素。 结果 两组患者在LVEF、LVEDD、CK-MB、BNP及Killip分级方面比较，差异有统计学意义(P<0.05);两组患者的住院时间比较，差异无统计学意义(P>0.05)。与D-to-B>90 min组相比，D-to-B≤90 min组的MACE发生率显著降低(P<0.05);多因素Logistic回归模型分析结果显示，D-to-B>90 min、LVEF及Killip分级≥Ⅱ级是AMI患者PCI术后出现MACE的危险因素(P<0.05)。 结论 缩短首诊急性心肌梗死患者入门至球囊扩张时间有助于改善患者预后，显著降低主要不良心血管事件的发生率。
[关键词] 急性心肌梗死;入门至球囊扩张时间;经皮冠状动脉介入治疗;主要不良心血管事件
[中图分类号] R542.22 [文献标识码] B [文章编号] 1673-9701(2020)31-0096-03
[Abstract] Objective To investigate the impacts of door to balloon(D-to-B) dilatation time of first diagnosed patients with acute myocardial infarction(AMI) on clinical therapeutic efficacy. Methods A total of 210 patients with AMI who were admitted to the chest pain center of our hospital from January 2018 to June 2019 were all treated with percutaneous coronary intervention(PCI)， with D-to-B time of 90 min as the cut-off point. Patients were divided into the D-to-B≤90 minutes group(n=90) and D-to-B>90 minutes group(n=120). The general clinical data and major adverse cardiac events(MACE) of the two groups were compared， and the risk factors of AMI patients after PCI operation were analyzed by multivariate Logistic regression model. Results There were statistically significant differences in LVEF， LVEDD， CK-MB，BNP and Killip classification between the two groups(P<0.05). There was no statistically significant difference in hospitalization time between the two groups(P>0.05). Compared with the D-to-B >90 minutes group， the incidence of MACE in the D-to-B ≤90 minutes group decreased significantly(P<0.05). The multivariate Logistic regression model analysis showed that D-to-B >90 minutes，LVEF and Killip classification ≥Ⅱ were the risk factors of MACE after PCI operation in patients with AMI(P<0.05). Conclusion Shortening the D-to-B dilatation time of first diagnosed patients with AMI can improve the prognosis of patients and significantly reduce the incidence of MACE.
[Key words]Acute myocardial infarction; Door-to-balloon dilatation time; Percutaneous coronary intervention therapy; Major adverse cardiovascular events
急性心肌梗死(Acute myocardial infarction，AMI)起病急、病勢进展快、病死率较高[1]。临床研究表明[2-3]，心肌细胞的缺血时间与急性心肌梗死患者的预后密切相关，最大限度地缩短发病与开通梗死相关动脉时间，是恢复心肌细胞再灌注、降低患者病死率的关键。入门至首次球囊扩张时间(Door to dalloon，D-to-B)是指从进入医院开始直至行PCI首次球囊扩张时间，该指标可反映行介入治疗医院的院内诊疗水平，2004年美国心脏学会(American heart association，AHA)/美国心脏病协会(American college of cardiology，ACC)对急性心肌梗死的管理指南中提出入门就诊至首次球囊扩张时间标准应<90 min[4]，该标准已作为医院急救流程质量的重要标准，本研究旨在考察首诊急性心肌梗死患者入门至球囊扩张时间对临床救治效果的影响，现报道如下。, http://www.100md.com(段洋 张凤云)
[关键词] 急性心肌梗死;入门至球囊扩张时间;经皮冠状动脉介入治疗;主要不良心血管事件
[中图分类号] R542.22 [文献标识码] B [文章编号] 1673-9701(2020)31-0096-03
[Abstract] Objective To investigate the impacts of door to balloon(D-to-B) dilatation time of first diagnosed patients with acute myocardial infarction(AMI) on clinical therapeutic efficacy. Methods A total of 210 patients with AMI who were admitted to the chest pain center of our hospital from January 2018 to June 2019 were all treated with percutaneous coronary intervention(PCI)， with D-to-B time of 90 min as the cut-off point. Patients were divided into the D-to-B≤90 minutes group(n=90) and D-to-B>90 minutes group(n=120). The general clinical data and major adverse cardiac events(MACE) of the two groups were compared， and the risk factors of AMI patients after PCI operation were analyzed by multivariate Logistic regression model. Results There were statistically significant differences in LVEF， LVEDD， CK-MB，BNP and Killip classification between the two groups(P<0.05). There was no statistically significant difference in hospitalization time between the two groups(P>0.05). Compared with the D-to-B >90 minutes group， the incidence of MACE in the D-to-B ≤90 minutes group decreased significantly(P<0.05). The multivariate Logistic regression model analysis showed that D-to-B >90 minutes，LVEF and Killip classification ≥Ⅱ were the risk factors of MACE after PCI operation in patients with AMI(P<0.05). Conclusion Shortening the D-to-B dilatation time of first diagnosed patients with AMI can improve the prognosis of patients and significantly reduce the incidence of MACE.
[Key words]Acute myocardial infarction; Door-to-balloon dilatation time; Percutaneous coronary intervention therapy; Major adverse cardiovascular events
急性心肌梗死(Acute myocardial infarction，AMI)起病急、病勢进展快、病死率较高[1]。临床研究表明[2-3]，心肌细胞的缺血时间与急性心肌梗死患者的预后密切相关，最大限度地缩短发病与开通梗死相关动脉时间，是恢复心肌细胞再灌注、降低患者病死率的关键。入门至首次球囊扩张时间(Door to dalloon，D-to-B)是指从进入医院开始直至行PCI首次球囊扩张时间，该指标可反映行介入治疗医院的院内诊疗水平，2004年美国心脏学会(American heart association，AHA)/美国心脏病协会(American college of cardiology，ACC)对急性心肌梗死的管理指南中提出入门就诊至首次球囊扩张时间标准应<90 min[4]，该标准已作为医院急救流程质量的重要标准，本研究旨在考察首诊急性心肌梗死患者入门至球囊扩张时间对临床救治效果的影响，现报道如下。, http://www.100md.com(段洋 张凤云)