不同急救方式对急性心肌梗死患者抢救结局的影响分析

卿希亮，王琴，张永昌，朱立

（旬阳县医院心血管内科，陕西 安康，725700）

浏览次数：71次 下载次数：372次

摘要：

目的 探讨不同急救方式对急性心肌梗死（AMI）患者抢救结局的影响。方法 回顾性分析我院2011年6月至2016年6月接诊的93例AMI患者的临床资料，观察本组患者急救时间，比较采用不同AMI 抢救方式后患者心功能分级以及抢救后 死亡发生率。结果 急诊转院PCI 治疗61例，溶栓治疗6例，其中2例溶栓后转上级医院补救PCI或CABG，内科治疗26 例。抢救时间：常规治疗>溶栓+PCI或CABG>溶栓>急诊PCI（P=0.000）；心功能分级：溶栓+PCI 或CABG>急诊PCI>溶栓>常规治 疗（P=0.000）；常规治疗患者死亡率最高，溶栓后转上级医院行PCI 治疗无死亡病例。结论 对于无PCI 条件的基层医院，溶栓 后转上级医院行PCI治疗可缩短患者的抢救时间，提高患者心功能评分，降低死亡率，是基层医院AMI 患者抢救的最佳方案。

关键词：急救方法；急性心肌梗死；抢救结局

中图分类号：R541文献标志码：A文章编号：2096-1413(2017)20-0031-02

Effect analysis of different emergency treatment methods on rescue outcome of patients with acute myocardial infarction
QING Xi-liang, WANG Qin, ZHANG Yong-chang, ZHU Li
(Department of Cardiovascular Internal Medicine, Xunyang County Hospital, Ankang 725700, China)

ABSTRACT: Objective To explore the effect of different emergency treatment methods on rescue outcome of patients with acute myocardial infarction. Methods From June 2011 to June 2016, the clinical data of 93 cases of patients with acute myocardial infarction in our hospital were retrospectively analyzed, the average emergency time, cardiac function classification and the mortality rate of different emergency treatment methods were compared. Results Sixty-one cases of patients received emergency transfer PCI; 6 cases received thrombolysis, and among them, 2 cases received remedial PCI or CABG after thrombolysis; 26 cases received conventional treatment in our hospital. Save time: conventional treatment>thrombolytic +PCI or CABG>thrombolysis>emergency PCI (P=0.000). Cardiac function classification: thrombolytic+PCI or CABG>emergency PCI>thrombolysis>conventional treatment (P=0.000); the mortality rate of patients underwent conventional treatment was the highest, that of patients received thrombolytic +PCI was the lowest. Conclusion For primary hospitals without PCI conditions, PCI therapy in superior hospital after thrombolysis could shorten rescue time, improve the cardiac function and reduce mortality, which is the best plan for rescuing acute myocardial infarction patients in primary hospital.
KEYWORDS: emergency methods; acute myocardial infarction; rescue outcome

参考文献：
[1] 方芳,张伟,乔旭柏,等.急性冠状动脉综合征患者易损斑块的临床病理分析[J].中华心血管病杂志,2011,39(9):802-806.
[2] 陈伟伟,高润霖,刘力生,等.中国心血管病报告2013概要[J].中国循环杂志,2014,29(7):487-491.
[3] 中华医学会心血管分会,中华心血管杂志编委会委员.急性ST 段抬高心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[4] 朱萍,丁嘉红.急性心肌梗死心电图的2007年修订标准[J].实用心电学杂志,2008,16(1):42-43.
[5] 张奇松,马成亮,朱慧,等.N末端B型钠尿肽原与美国纽约心脏病学会心功能分级在心衰诊断中的相关性对比分析[J].工企医刊,2012,25(6):42-43.
[6] 高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者心血管危险因素分析[J].中国循环杂志,2015,30(3):206-210.
[7] 孔令璁,何奔.非ST段抬高型急性冠状动脉综合征介入时机的选择[J].中华心血管病杂志,2015,43(1):79-81.