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目的初步了解深圳市公立医院急性ST段抬高型心肌梗死(STEMI)患者的救治现状。方法在深圳市公立医院管理中心行政指令下,由深圳市人民医院胸痛救治质量管理与控制中心(以下简称“深圳市胸痛质控中心”)牵头,选取深圳市25家公立医院[包括15家具备经皮冠状动脉介入治疗(PCI)医院和10家非PCI医院],进行胸痛救治医院综合条件和2015年10-12月STEMI患者救治情况的基线调查。结果总计纳入深圳市25家公立医院2015年10-12月383例STEMI患者,其中15家PCI医院组324例,10家非PCI医院组59例。PCI医院根据心内科开放床位数均配备了相应数量心内科专科医师并设立有冠心病重症监护室(CCU)。PCI医院组工作≥3年心内科专科医师人数[(18±6)人比(6±2)人,P<0.001],心内科床位数[(62±8)张比(25±3)张,P<0.001],CCU/心脏重症专用床位数[(6±4)张比(3±1)张,P=0.008]均显著高于非PCI医院组,差异均有统计学意义。两组医院均具备床旁完成18导联心电图(ECG)能力,首份ECG完成时间比较,差异无统计学意义(P=0.052)。PCI医院在快速检测肌钙蛋白、D-二聚体(100.0%比30.0%,P=0.001),肌钙蛋白检测完成时间[(25.0±4.2)min比(58.0±2.8)min,P=0.002]均明显优越于非PCI医院组。而在建立ECG远程传输信息平台方面,非PCI医院组优于PCI医院组(80.0%比20.0%,P=0.005)。PCI医院组建立完善的急性冠状动脉综合征(ACS)救治流程图(100.0%比80.0%,P=0.042),具备安装临时起搏器能力医院比例(100.0%比10.0%,P=0.002),配备安装主动脉内球囊反搏(IABP)能力的医院比例(80.0%比0,P=0.001)均优于非PCI医院组,差异均有统计学意义。PCI医院组STEMI患者到达医院至球囊开通最短时间为25 min,最长时间为720 min,平均时长为320.3 min;首次医疗接触至球囊开通最短时间为25 min,最长时间为856 min,平均时长为380.2 min;到达医院至溶栓开始(D-to-N)最短时间为70 min,最长时间为756 min。而非PCI医院组D-to-N最短时间20 min,最长350 min。因溶栓总病例数仅有8例,数量过少,未进行统计学分析。结论非PCI医院在医院综合条件和胸痛救治水平较PCI医院差距大。
Objective To understand the treatment status of STEMI patients in Shenzhen public hospital. Methods Under the administrative instruction of Shenzhen Public Hospital Management Center, Shenzhen Chest Pain Relief Treatment Quality Management and Control Center (hereinafter referred to as “Shenzhen Chest Pain Control Center”) led by 25 public hospitals in Shenzhen [including 15 Furniture percutaneous coronary intervention (PCI) hospital and 10 non-PCI hospitals] were recruited to carry out a baseline survey of comprehensive conditions of chest pain relief hospital and STEMI patients from October to December 2015. The results were included in 383 STEMI patients in 25 public hospitals in Shenzhen from October to December 2015, of which 324 were from 15 PCI hospitals and 59 from 10 non-PCI hospitals. PCI hospitals are equipped with a corresponding number of cardiologist and cardiology intensive care unit (CCU) according to the number of open beds in cardiology department. The number of cardiologist (≥6 ± 2) in PCI hospital group ≥3 years (P <0.001), [62 ± 8) (25 ± 3) , P <0.001]. The number of beds for CCU / severe cardia [6 ± 4 (3 ± 1), P = 0.008] were significantly higher than those in non-PCI hospital. There was no statistically significant difference between the two groups of hospitals with the 18-lead electrocardiogram (ECG) ability at the bedside. The difference was not statistically significant (P = 0.052). The PCI hospital had a rapid detection of troponin, D-dimer (100.0% vs. 30.0%, P = 0.001), time to completion of troponin testing [(25.0 ± 4.2) min vs (58.0 ± 2.8) min, P = 0.002 ] Were significantly superior to non-PCI hospital group. However, non-PCI hospital group was superior to PCI hospital group (80.0% vs. 20.0%, P = 0.005) in establishing ECG remote transmission information platform. The PCI hospital established a complete flow chart for the treatment of acute coronary syndrome (ACS) (100.0% vs. 80.0%, P = 0.042), hospital-installed temporary pacemaker capacity (100.0% vs 10.0%, P = 0.002) The proportion of hospitals equipped with IABP (80.0% vs 0, P = 0.001) was better than that of non-PCI hospital, with significant differences. The shortest time to reach the hospital when the STEMI patients arrived in the PCI hospital group was 25 min and the longest time was 720 min and the average duration was 320.3 min. The shortest time for the first medical contact until the balloon was opened was 25 min and the longest time was 856 min, The average duration was 380.2 min. The shortest time to reach the hospital from the beginning of thrombolytic therapy (D-to-N) was 70 min and the longest time was 756 min. Non-PCI hospital group D-to-N minimum time of 20 min, the longest 350 min. Due to the total number of thrombolytic cases only 8 cases, the number is too small, no statistical analysis. Conclusion Non-PCI hospital in the hospital comprehensive conditions and chest pain treatment level than the PCI hospital gap.