中华灾害救援医学

目的 探讨胸痛中心“全市模式”对急性ST段抬高型心肌梗死(STEMI)患者救治效率和临床预后的影响。方法 采用回顾性队列研究,收集2021年1月至2023年12月龙岩市第一医院收治的STEMI患者资料,按“全市模式”实施阶段分为三组:A组(未建立期,325例)、B组(建立初期,322例)和C组(建立成熟期,340例)。比较三组患者的非PCI医院停留时间(DIDO)、首次医疗接触至导丝通过时间(FMC2W)、入门至导丝通过时间(D2W)、导管室激活时间等效率指标,以及绕行急诊及CCU比例、再灌注率、院内死亡率和并发症(心衰、出血、再梗死)发生率。结果 与A、B两组相比,C组在DIDO、FMC2W、D2W及导管室激活时间均显著缩短(P<0.05);绕行急诊及CCU比例、FMC2W达标率、D2W达标率及再灌注率均显著提高(P<0.05);同时,C组院内死亡率及各项并发症发生率均显著降低(P<0.05)。结论 胸痛中心“全市模式”能有效优化STEMI救治流程,显著缩短院内再灌注时间,提高救治效率,并与患者死亡率和并发症发生率的降低显著相关。

Objective To investigate the impact of the chest pain center "city-wide model" on treatment efficiency and clinical outcomes in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods A retrospective cohort study was conducted using data from STEMI patients admitted to Longyan First Hospital between January 2021 and December 2023. Patients were divided into three groups based on the implementation phase of the "city-wide model" : Group A(pre-establishment phase, n=325), Group B(early establishment phase, n=322), and Group C(mature phase, n=340). Efficiency metrics, including door-in-door-out time(DIDO), first medical contact-to-wire time(FMC2W), door-to-wire time(D2W), and catheterization laboratory activation time, were compared among the groups. Additionally, the rates of emergency department and CCU bypass, reperfusion, in-hospital mortality, and complications(heart failure, bleeding, reinfarction) were analyzed. Results Compared with Groups A and B, Group C showed significant reductions in DIDO, FMC2W, D2W, and catheterization laboratory activation time(P<0.05). The rates of emergency department and CCU bypass, FMC2W compliance, D2W compliance, and reperfusion were significantly higher in Group C(P<0.05). Moreover, Group C had significantly lower in-hospital mortality and complication rates(P<0.05). Conclusion The chest pain center "city-wide model" effectively optimizes the STEMI treatment process, significantly shortens in-hospital reperfusion time, improves treatment efficiency, and is associated with reduced mortality and complication rates. It is worthy of broader implementation.