目的 观察优化急性心肌梗死(acute myocardial infarction, AMI)急诊路径管理对血管再通治疗的影响。方法 回顾性分析了1995-01至2011-12共1134例ST段抬高型心肌梗死患者( ST segment elevation myocardial infarction, STEMI )急诊血管再通治疗情况及时间截点。分析在急性心肌梗死急诊路径管理下，患者急诊静脉溶栓和急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)逐年变化情况，及急诊静脉溶栓联合PCI治疗（易化PCI治疗)和直接PCI对临床的影响，分析患者发病-来诊时间、来诊-静脉溶栓时间(门-针时间)和来诊-急诊PCI时间(门-球时间)变化情况。自2004年进一步优化管理路径，取消心内科会诊，加强了时间截点管理等措施，分析优化前后变化情况。结果 急诊PCI患者人数逐年增加，2004年急诊PCI患者人数开始多于静脉溶栓人数；患者发病-来诊时间17年间变化不大，患者来诊-静脉溶栓时间和来诊-急诊PCI时间2004年后有明显缩短。 易化PCI不能降低住院病死率。结论 急性心肌梗死急诊路径的实施，逐年缩短了急性心肌梗死患者来诊至救治时间，可以挽救濒死心肌，对急诊临床工作有很好的指导和帮助作用。易化PCI较直接PCI相比不能改善临床预后。
Abstract
Objective To measure the effect of a clinical pathway on patients with acute myocardial infarction (AMI) in emergency departments. Methods The effectiveness of a multidisciplinary clinical pathway for AMI patients over the past seventeen years in our emergency department was retrospectively analyzed. The clinical pathways used before 2004 and after 2004 were compared. The measurement involed the time to room, time of door-to-needle, time of door-to-balloon. We also compared the effect of clinical outcomes of facilitated PCI (venous thromblysis plus PCI, percutaneous coronary intervention ) and primary PCI. Results A total of 1134 ST-segment elevation myocardial infarction (STEMI) patients were analyzed. The number of acute PCI patients increased while the time of door-to-needle time and door-to-balloon decreased significantly since 2004. However, time to room didn’t change much. Facilitated PCI could not improve in-hospital survival compared with the primary PCI. Conclusion The clinical pathway can shorten the time of door-to-needle and door-to-balloon for AMI patients. Facilitated PCI fails to improve the clinical outcomes when compared with primary PCI.
关键词
急诊路径 /
急性心肌梗死 /
门-针时间 /
门-球时间
Key words
clinical pathway /
acute myocardial infarction /
door-to-needle time /
door-to-balloon time
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参考文献
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基金
北京市科委资助课题(编号：D0905002040511)
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