临床路径对ST段抬高心肌梗死患者再灌注治疗疗效的影响
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深圳市科技研究项目(201102181)


Impact of Clinical Pathways on the Curative Effect of Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infraction
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    摘要:

    目的评价临床路径对急性ST段抬高心肌梗死患者就诊至球囊扩张时间、梗死心肌的再灌注治疗疗效的影响。方法 随机选择100例实施急性ST段抬高心肌梗死急诊冠状动脉介入术临床路径的患者作为试验组,同时随机选择100例同期未实施临床路径的急性ST段抬高心肌梗死急诊冠状动脉介入术的住院患者为对照组。主要观察指标是就诊至球囊扩张时间、90 min目标时间内完成球囊扩张的比例、术中心肌梗死介入治疗后3级血流获得率及术后90 min ST段回落的比例、肌酸激酶同工酶酶峰值、住院病死率。结果试验组就诊至球囊扩张时间显著短于对照组(中位数,65 min比95 min,p<0.001),就诊90 min内完成球囊扩张的比例显著高于对照组(98%比65%,p<0.001)。临床路径显著提高术中心肌梗死介入治疗3级血流获得率(94%比81%,p<0.05)及术后90 min ST段回落>50%的比例(88%比67%,p<0.05),肌酸激酶同工酶酶峰值也明显提前(7.8±0.5比10.1±0.4,p<0.05),试验组住院病死率显著低于对照组(2%比7%,p<0.001)。结论临床路径可显著缩短就诊至球囊扩张时间,增加了90 min目标时间内完成球囊扩张的比例,能够更好地改善梗死区域心肌的微循环,显著提高梗死心肌的再灌注治疗疗效,这一作用对于降低住院病死率也具有非常显著的帮助,证实了临床路径管理是一种新的行之有效的服务管理模式。

    Abstract:

    AimTo evaluate the effect of clinical pathways on door-to-balloon (D2B) time, the curative effect of myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI).Methods100 patients treated with STEMI emergency percutaneous coronary intervention (PCI) clinical pathways were chosen randomly as the experimental group while 100 un-treated patients were chosen as the control group.The primary observation indexes are: D2B time, the number of cases achieving thrombolysis in myocardial infarction (TIMI) 3 flow, lowering of ST segment 90 min after PCI, the time to peak serum creatine kinase-mb (CK-MB) levels and in-hospital mortality rate.ResultsThe D2B time of experimental group was significantly shorter than that of control group (Median, 65 min vs 95 min, p<0.001), and the number of patients receiving primary PCI within the guideline-recommended 90 min was greater in the experimental group than in the control group (98% vs 65%, p<0.001).More patients achieved TIMI 3 flow (94% vs 81%, p<0.05) and lowering of ST segment 90 min after PCI (88% vs 67%, p<0.05) than those in control group.Time to peak serum CK-MB levels was evidently improved (7.8±0.5 vs 10.1±0.4, p<0.05) and in-hospital mortality rate of the experimental group was significantly less than the control group (2% vs 7%, p<0.001).ConclusionsClinical pathways were associated with a significantly shorter D2B time, the increase of the proportion of patients undergoing primary PCI within 90 min of hospital arrival.It could also help to significantly improve the myocardial microcirculation of the infraction area, evidently promote the curative effect of myocardial reperfusion in acute myocardial infarction and reduce the in-hospital mortality rate.

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李忠红,王丽丽,刘强,曹倩,罗颖,田芳,耿庆山.临床路径对ST段抬高心肌梗死患者再灌注治疗疗效的影响[J].中国动脉硬化杂志,2012,20(6):545~548.

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  • 收稿日期:2012-03-20
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