马伟萍　　王治平

[摘要] 目的 探討胸痛中心模式对急性ST段抬高型心肌梗死（STEMI）再灌注治疗及预后的影响。 方法 选取2017年9月至2018年8月长治医学院附属和平医院胸痛中心成立后收治的STEMI 200例为研究组，2016年9月至2017年8月胸痛中心成立前收治的STEMI153例为对照组，分别收集两组发病至首次医疗处理时间、首份心电图完成时间、就诊至再灌注时间（球囊扩张或溶栓），住院期间NT-proBNP、左心室射血分数（LVEF）、左室舒张末内径（LVDD）、左室收缩末内径（LVSD）、Killip分级及心力衰竭、恶性心律失常、房颤、室壁瘤及院内死亡发生率，平均住院天数及费用，出院1年后死亡、再入院、心衰及再发心绞痛发生率。 结果 研究组中首次医疗处理时间、首份心电图完成时间、就诊至再灌注时间、住院期间NT-proBNP及心力衰竭、恶性心律失常、房颤发生率均低于对照组（P<0.05），同时研究组LVEF高于对照组（P<0.05）;另外与对照组相比，研究组住院天数也缩短（P<0.05）;在出院后1年随访中STEMI患者死亡、再入院、心衰及再发心绞痛发生率研究组均低于对照组（P<0.05）。 结论 胸痛中心运行模式进一步提高了STEMI再灌注治疗的水平，缩短心肌总缺血时间，改善了患者的心功能以及降低了STEMI终点时间的发生率。

[关键词] 急性ST段抬高型心肌梗死;胸痛中心;再灌注治疗;救治效果;预后

[中图分类号] R542.2          [文献标识码] B          [文章编号] 1673-9701（2021）13-0050-04

Influence of chest pain center model on reperfusion therapy and clinical prognosis of acute ST-segment elevation myocardial infarction

MA Weiping1   WANG Zhiping2

1.Department of Cardiovascular Medicine， Changzhi Medical College， Changzhi   046000， China; 2.Cardovascular Medicine Heping Hospital Affiliated to Changzhi Medical College， Changzhi   046000， China

[Abstract] Objective To investigate the impact of establishing a chest pain center on the reperfusion therapy and prognosis of acute ST-segment elevation myocardial infarction（STEMI）. Methods 200 cases of STEMI admitted to the chest pain center of the Heping Hospital Affiliated to Changzhi Medical College from September 2017 to August 2018 were selected as the study group， and 153 cases of STEMI admitted in the chest pain center from September 2016 to August 2017 were selected as the control group. The time from onset to the first medical treatment， the time to complete the first ECG， the time from visit to reperfusion（balloon dilation or thrombolysis）， NT-proBNP， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVDD） during hospitalization were collected in the two groups （LVDD）， left ventricular end-systolic diameter（LVSD）， Killip grade， and the incidence of heart failure， malignant arrhythmia， atrial fibrillation， ventricular aneurysm， and in-hospital mortality during the hospitalization， the average length of stay and cost， the incidence of death after one year of discharge， re-admission， heart failure， and recurrent angina pectoris one year after discharge in two groups were collected separately. Results The first medical treatment time， the first ECG completion time， the time from visit to reperfusion， the NT-proBNP， the incidence of heart failure， malignant arrhythmia， and atrial fibrillation during hospitalization in the study group were lower than those in the control group（P<0.05）. The LVEF of the study group was higher than that of the control group（P<0.05）. The length of stay in the study group was also shorter than that of the control group（P<0.05）. The incidence of death， re-admission， heart failure， and recurrent angina in STEMI patients of the study group was lower than that of the control group during the 1-year follow-up after discharge（P<0.05）. Conclusion The operation mode of the chest pain center further improves the level of STEMI reperfusion therapy， shortens the total ischemic time of the myocardium， improves the patient's cardiac function and reduces the incidence of STEMI endpoint time.

[Key words] Acute ST-segment elevation myocardial infarction; Chest pain center; Reperfusion therapy; Rescue effect; Prognosis

急性心肌梗死（acute myocardial infarction，AMI）是临床心血管内科的急诊病症，越来越多地人正在饱受AMI的疾痛折磨。社会的不断进步，经济的飞速发展，使人民生活水平日益提高，健康得以保障，从而加速了人口老龄化进程，致使心血管疾病罹患人数持续增加。估计2030年中国AMI患者将达到2300万[1]。ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）是心肌梗死的主要类型，占80%以上[2-3]，具有起病迅速、进展过程快、病死率高、预后差等特点，所以积极有效的预防和治疗必不可少。针对AMI患者的救治，公认的方法是尽早对梗死血管进行再灌注治疗，使被阻塞梗死的血管开通，从而恢复受阻血管的血液供应。……