吴雅芳++郭拥军

[摘要] 目的 探討优化急性ST段抬高型心肌梗死（STEMI）绿色通道对缩短入门-球囊（DTB）时间的影响，及对平均住院日、平均住院费用、死亡率、GRACE评分的影响。 方法 收集2014年1月～2015年12月就诊于厦门大学附属第一医院经急性心肌梗死绿色通道直接经皮冠状动脉介入治疗（PCI）的STEMI患者共126例，其中，优化急性心肌梗死绿色通道前收治的患者61例，为对照组；优化急性心肌梗死绿色通道后收治的患者65例，为观察组。比较两组DTB时间、平均住院日、平均住院费用、GRACE评分、死亡情况。 结果 两组患者基本情况比较，差异无统计学意义（P > 0.05）。与对照组相比，观察组DTB时间明显缩短，平均住院日明显缩短，平均住院费用显著减少，出院GRACE评分明显减少，差异有统计学意义（P < 0.05）。观察组院内死亡率有下降趋势，但两组之间差异无统计学意义（P > 0.05）。随访至6个月，观察组死亡率明显低于对照组，差异有统计学意义（P < 0.05）。 结论 优化急性心肌梗死绿色通道能显著降低DTB时间，降低平均住院日、平均住院费用、出院时GRACE评分，降低死亡率。

[关键词] 急性心肌梗死；绿色通道；入门-球囊时间

[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-7210（2017）01（b）-0074-04

Investigation of door-balloon time reduction based on optimized green channel for patients with ST-elevation myocardial infarction

WU Yafang GUO Yongjun▲

Department of Cardiology， the First Affiliated Hospital of Xiamen University The Institute of Cardiovascular Disease of Xiamen， Fujian Province， Xiamen 361003， China

[Abstract] Objective To assess the effect of optimized green channel for patients with acute ST-elevation myocardial infarction （STEMI） on reduction of door to balloon time， average hospital stay， in-hospital cost， mortality and influence on GRACE score. Methods 126 patients with STEMI underwent primary percutaneous coronary interention （PCI） though acute myocardial infarction green channel in the First Affiliated Hospital of Xiamen University from January 2014 to December 2015 were enrolled in this observational study. 61 patients admitted before the optimization of green channel were regarded as control group， while 65 patients admitted after the optimization of green channel were regarded as observation group. Median door to balloon time， average hospital stay， in-hospital cost， GRACE score at discharge， and mortality were compared between the two groups. Results There were no significant differences in the baseline characteristics between the two groups （P > 0.05）. Compared with control group， the observation group had notably shortened door to balloon time， obviously decreased average hospital stay， significantly lowered in-hospital cost， and greatly reduced GRACE score at discharge （P < 0.05）. There was a downward trend of mortality in observation group but no significant difference in the two groups （P > 0.05）. According to the 6-month follow-up result， it was observed that mortality in observation group was significantly lower than control group， with statistically significant difference （P < 0.05）. Conclusion Optimized green channel for patients with STEMI can significantly reduce door to balloon time， average hospital days， in-hospital cost， lower GRACE score at discharge and mortality at 6 months follow-up.

[Key words] Acute myocardial infarction； Green channel； Door to balloon time

急性心肌梗死是严重的临床疾病[1-2]，及时有效开通梗死血管、恢复心肌有效灌注可减少心肌梗死面积[3]。直接经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）是急性ST段抬高型心肌梗死（ST segment elevation myocardial infarction，STEMI）最佳治疗方法[4-6]。急性心肌梗死的PCI绿色通道为抢救患者争取更多的时间，从而争取更好存活率和预后。但实际上许多绿色通道通而不畅，存在一些弊端[7-8]。美国心脏病协会（ACC/AHA）、欧洲心脏病学会（ESC）和中华医学会心血管病学分会均建议尽早血运重建[9-11]。本研究通过观察比较优化急性心肌梗死绿色通道前后的入门-球囊（door to balloon，DTB）时间、平均住院日、平均住院費用、GRACE评分、死亡情况，评价优化急性心肌梗死绿色通道的效应。