唐聚花，劉 青，李 娜，李芝明

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·論著·

·急診急救·

優(yōu)化綠色通道對(duì)ST段抬高型心肌梗死直接經(jīng)皮冠狀動(dòng)脈介入治療的影響

唐聚花，劉 青，李 娜，李芝明

背景 心血管疾病是嚴(yán)重威脅廣大人民群眾健康的疾病，每年全世界約有1 670萬人死于心血管疾病。在我國(guó)，冠狀動(dòng)脈粥樣硬化性心臟病(CAHD)也是威脅人民群眾健康的首要心血管疾病，每年約有70萬人死于CAHD。CAHD的治療方法中，針對(duì)ST段抬高型心肌梗死(STEMI)的治療手段主要是直接經(jīng)皮冠狀動(dòng)脈介入治療(PCI)。目的 分析優(yōu)化綠色通道對(duì)STEMI患者直接PCI延遲時(shí)間及預(yù)后的影響，為臨床工作者對(duì)STEMI急診救治工作提供理論依據(jù)。方法 選取2013—2014年于鄭州人民醫(yī)院通過優(yōu)化后綠色通道行直接PCI的符合納入標(biāo)準(zhǔn)的STEMI患者117例為試驗(yàn)組?；仡櫺赃x取2011—2012年于鄭州人民醫(yī)院通過優(yōu)化前綠色通道行直接PCI的符合納入標(biāo)準(zhǔn)的STEMI患者107例為對(duì)照組。記錄患者一般資料、延遲時(shí)間〔患者出現(xiàn)癥狀到報(bào)警時(shí)間、120接警時(shí)間、指派急救站時(shí)間、接受任務(wù)到出診時(shí)間、出診到抵達(dá)現(xiàn)場(chǎng)時(shí)間、現(xiàn)場(chǎng)到首次醫(yī)療接觸時(shí)間、首次醫(yī)療接觸到首份心電圖時(shí)間、首次醫(yī)療接觸到口服雙抗藥物(阿司匹林腸溶片300 mg、氯吡格雷600 mg)時(shí)間、急診醫(yī)師初步告知病情到患者理解時(shí)間、院前遠(yuǎn)程會(huì)診及導(dǎo)管室預(yù)激活時(shí)間、待診專科醫(yī)師二次告知并簽字時(shí)間、入導(dǎo)管室到球囊擴(kuò)張時(shí)間、進(jìn)門到球囊擴(kuò)張時(shí)間(D2B)〕、預(yù)后因素〔TIMI心肌灌注分級(jí)(TMP)、30 d病死率、PCI后嚴(yán)重不良心血管事件(心力衰竭、心律失常、心源性休克、復(fù)流后再梗死)發(fā)生率〕。結(jié)果 試驗(yàn)組患者出現(xiàn)癥狀到報(bào)警時(shí)間、120接警時(shí)間、指派急救站時(shí)間、首次醫(yī)療接觸到首份心電圖時(shí)間、首次醫(yī)療接觸到口服雙抗藥物時(shí)間、待診專科醫(yī)師二次告知并簽字時(shí)間、D2B短于對(duì)照組，急診醫(yī)師初步告知病情到患者理解時(shí)間、院前遠(yuǎn)程會(huì)診及導(dǎo)管室預(yù)激活時(shí)間長(zhǎng)于對(duì)照組(P<0.05)；兩組接受任務(wù)到出診時(shí)間、出診到抵達(dá)現(xiàn)場(chǎng)時(shí)間、現(xiàn)場(chǎng)到首次醫(yī)療接觸時(shí)間、入導(dǎo)管室到球囊擴(kuò)張時(shí)間比較，差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。試驗(yàn)組TMP高于對(duì)照組，30 d病死率、心力衰竭發(fā)生率、心律失常發(fā)生率、心源性休克發(fā)生率、復(fù)流后再梗死發(fā)生率低于對(duì)照組(P<0.05)。結(jié)論 優(yōu)化綠色通道可縮短STEMI患者直接PCI延遲時(shí)間，并改善患者預(yù)后。

心肌梗死；血管成形術(shù)，氣囊，冠狀動(dòng)脈；急救；綠色通道；延遲；預(yù)后

唐聚花，劉青，李娜，等.優(yōu)化綠色通道對(duì)ST段抬高型心肌梗死直接經(jīng)皮冠狀動(dòng)脈介入治療的影響[J].中國(guó)全科醫(yī)學(xué)，2016，19(36)：4499-4503.[www.chinagp.net]

TANG J H,LIU Q,LI N,et al.Effect of application of optimized green channel on ST-elevation myocardial infarction with primary percutaneous coronary intervention[J].Chinese General Practice，2016，19(36)：4499-4503.

心血管疾病是嚴(yán)重威脅廣大人民群眾健康的疾病，每年全世界約有1 670萬人死于心血管疾病，而其中80%發(fā)生在發(fā)展中國(guó)家并且有逐漸年輕化的趨勢(shì)[1]。ST段抬高型心肌梗死(acute ST-segment elevated myocardial infarction，STEMI)是心血管疾病中的急危重癥之一。在美國(guó)每年約有120萬人發(fā)生心肌梗死，而這其中有1/4～1/3是STEMI[2-3]。有25%～35%患者常在就診前發(fā)生心室纖顫而死亡[4]，經(jīng)過治療的患者院內(nèi)死亡率仍達(dá)5.7%，而未經(jīng)治療的患者其院內(nèi)死亡率更是達(dá)14.8%[5]。有研究表明，這些患者如在發(fā)病24 h內(nèi)得不到有效的診療，約1/3患者會(huì)因此死亡[6]。在我國(guó)，冠狀動(dòng)脈粥樣硬化性心臟病(coronary atherosclerotic heart disease，CAHD)也是威脅人民群眾健康的首要心血管疾病，是致殘、致死的主要原因之一，每年約有70萬人死于CAHD，約占死亡人數(shù)的1/4[7]。直接經(jīng)皮冠狀動(dòng)脈介入治療(percutaneous coronary intervention，PCI)是STEMI的主要治療手段。目前認(rèn)為，急診PCI是STEMI患者實(shí)現(xiàn)心肌完全再灌注的最佳手段，但其獲益具有明顯的時(shí)間依賴性[8]。本研究比較STEMI患者接受直接PCI綠色通道中自我反應(yīng)階段、急救服務(wù)系統(tǒng)反應(yīng)階段、院前急救階段、院內(nèi)急救階段的延遲因素，并比較優(yōu)化綠色通道與未優(yōu)化綠色通道的TIMI心肌灌注分級(jí)(TMP)、30 d病死率及PCI后嚴(yán)重不良心臟事件發(fā)生率，分析院前延遲因素對(duì)患者的影響，總結(jié)和歸納減少院前延遲的原因，為臨床工作者對(duì)STEMI急診救治工作提供理論依據(jù)。

1 對(duì)象與方法

1.1 研究對(duì)象 選取2013—2014年于鄭州人民醫(yī)院通過優(yōu)化后綠色通道行直接PCI的符合納入標(biāo)準(zhǔn)的STEMI患者117例為試驗(yàn)組?；仡櫺赃x取2011—2012年于鄭州人民醫(yī)院通過優(yōu)化前綠色通道行直接PCI的符合納入標(biāo)準(zhǔn)的STEMI患者107例為對(duì)照組。納入標(biāo)準(zhǔn)：(1)首份心電圖確診為急性STEMI；(2)發(fā)病在12 h及其以內(nèi)的患者，即從患者出現(xiàn)癥狀到再灌注的時(shí)間≤12 h；(3)無直接PCI禁忌證；(4)患者近親屬及其法定代理人知情同意并簽署知情同意書；(5)本院首診；(6)救護(hù)車接入。排除標(biāo)準(zhǔn)：患者有明顯的可能會(huì)影響到療效評(píng)價(jià)的其他疾病(如晚期癌癥、先天性心臟病等)。本研究獲得本院倫理委員會(huì)的審核并通過，項(xiàng)目實(shí)施過程中受到倫理委員會(huì)的監(jiān)督。

1.2 研究方法

1.2.1 一般資料收集 記錄患者一般資料，包括性別、年齡、既往病史(包括心絞痛、腦卒中、高血壓、糖尿病、高脂血癥、慢性腎功能不全)類型及種數(shù)、吸煙史等。其中吸煙定義為一生中連續(xù)或累積吸煙6個(gè)月或以上。

1.2.2 延遲時(shí)間收集 包括自我反應(yīng)延遲時(shí)間(患者出現(xiàn)癥狀到報(bào)警時(shí)間)、醫(yī)療反應(yīng)延遲時(shí)間(120接警時(shí)間、指派急救站時(shí)間、接受任務(wù)到出診時(shí)間、出診到抵達(dá)現(xiàn)場(chǎng)時(shí)間)、救治現(xiàn)場(chǎng)延遲時(shí)間〔現(xiàn)場(chǎng)到首次醫(yī)療接觸時(shí)間、首次醫(yī)療接觸到首份心電圖時(shí)間、首次醫(yī)療接觸到口服雙抗藥物(阿司匹林腸溶片300 mg、氯吡格雷600 mg)時(shí)間〕、轉(zhuǎn)運(yùn)延遲時(shí)間(急診醫(yī)師初步告知病情到患者理解時(shí)間、院前遠(yuǎn)程會(huì)診及導(dǎo)管室預(yù)激活時(shí)間)、院內(nèi)延遲時(shí)間〔待診?？漆t(yī)師二次告知并簽字時(shí)間、入導(dǎo)管室到球囊擴(kuò)張時(shí)間、進(jìn)門到球囊擴(kuò)張時(shí)間(door to balloon dilatation，D2B)〕。

1.2.3 預(yù)后因素收集 包括TMP、30 d病死率和PCI后嚴(yán)重不良心血管事件(心力衰竭、心律失常、心源性休克、復(fù)流后再梗死)發(fā)生率。

2 結(jié)果

2.1 一般資料比較 兩組患者性別、年齡、心絞痛發(fā)生率、腦卒中發(fā)生率、高血壓發(fā)生率、糖尿病發(fā)生率、高脂血癥發(fā)生率、慢性腎功能不全發(fā)生率、既往病史種類數(shù)、吸煙率比較，差異均無統(tǒng)計(jì)學(xué)意義(P>0.05，見表1)。

2.2 延遲時(shí)間比較 試驗(yàn)組患者出現(xiàn)癥狀到報(bào)警時(shí)間、120接警時(shí)間、指派急救站時(shí)間、首次醫(yī)療接觸到首份心電圖時(shí)間、首次醫(yī)療接觸到口服雙抗藥物時(shí)間、待診?？漆t(yī)師二次告知并簽字時(shí)間、D2B短于對(duì)照組，急診醫(yī)師初步告知病情到患者理解時(shí)間、院前遠(yuǎn)程會(huì)診及導(dǎo)管室預(yù)激活時(shí)間長(zhǎng)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；兩組接受任務(wù)到出診時(shí)間、出診到抵達(dá)現(xiàn)場(chǎng)時(shí)間、現(xiàn)場(chǎng)到首次醫(yī)療接觸時(shí)間、入導(dǎo)管室到球囊擴(kuò)張時(shí)間比較，差異無統(tǒng)計(jì)學(xué)意義(P>0.05，見表2)。

2.3 預(yù)后比較 試驗(yàn)組TMP高于對(duì)照組，30d病死率、心力衰竭發(fā)生率、心律失常發(fā)生率、心源性休克發(fā)生率、復(fù)流后再梗死發(fā)生率低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義(P<0.05，見表3)。

3 討論

CAHD是指冠狀動(dòng)脈發(fā)生粥樣硬化引起管腔狹窄或閉塞，導(dǎo)致心肌缺血缺氧或壞死而引起的心臟病，簡(jiǎn)稱冠心病(coronaryheartdisease，CHD)[9]。心肌細(xì)胞死亡從冠狀動(dòng)脈阻塞后20min內(nèi)開始[10]，通常整個(gè)過程持續(xù)6h[8]，及早地介入干預(yù)將明顯延緩這一過程的進(jìn)展[11-12]。因此，應(yīng)采取各種方式減少包括院前及院內(nèi)的延遲，以期盡早實(shí)施干預(yù)措施減少心肌梗死面積、迅速重建血流、降低死亡率[10]。

表1 兩組患者一般資料比較

注：a為t值

表2 兩組患者延遲時(shí)間比較〔M(QR)〕

注：D2B=進(jìn)門到球囊擴(kuò)張時(shí)間

表3 兩組患者預(yù)后比較

注：TMP=TIMI心肌灌注分級(jí)

3.1 患者自身因素的改善對(duì)延遲的影響 患者發(fā)病到最后獲得再灌注的延遲主要分成兩個(gè)方面，分別是院前延遲和院內(nèi)延遲[13]。院內(nèi)延遲指的是從患者抵達(dá)醫(yī)院到患者獲得再灌注治療的這一段時(shí)間，即常用的D2B[14]，美國(guó)心臟病學(xué)會(huì)/美國(guó)心臟學(xué)會(huì)(ACC/AHA)將此時(shí)間設(shè)置為≤90 min，并將D2B≤90 min作為評(píng)價(jià)再灌注治療的主要考核指標(biāo)[15]。本院急診科長(zhǎng)期從事醫(yī)院周邊社區(qū)的醫(yī)療健康知識(shí)宣講活動(dòng)和急診急救知識(shí)普及工作，本研究結(jié)果顯示，試驗(yàn)組患者出現(xiàn)癥狀到報(bào)警時(shí)間短于對(duì)照組，這可能是相關(guān)知識(shí)普及工作的成效，當(dāng)然也不能排除人口素質(zhì)本身的提高及對(duì)疾病認(rèn)識(shí)的改變等因素。

3.2 急救醫(yī)療服務(wù)(emergency medical service，EMS)系統(tǒng)對(duì)延遲的影響 EMS是指對(duì)心血管病患者在事發(fā)現(xiàn)場(chǎng)、轉(zhuǎn)送途中以及入院后得到有效合理救治的醫(yī)療服務(wù)，包括院前急救和院內(nèi)急救[16]。EMS由急救醫(yī)療服務(wù)系統(tǒng)(emergency medical service system，EMSS)提供[15]。在我國(guó)，EMS主要由院前急救組織(包括急救中心、急救分中心、急救站組成的院前急救網(wǎng)絡(luò))、院內(nèi)急救組織(包括各類具有急救能力的醫(yī)院和其他專業(yè)醫(yī)療機(jī)構(gòu))、一些具有急救功能的社會(huì)組織和具有急救能力的個(gè)人實(shí)施。本研究結(jié)果顯示，試驗(yàn)組120接警時(shí)間、指派急救站時(shí)間短于對(duì)照組，說明通過多年的持續(xù)投入與建設(shè)，院前調(diào)度的接警及分派能力進(jìn)一步提升，在以電話報(bào)警后再分派急救站點(diǎn)模式不變的情況下，縮短接警和指派出診的時(shí)耗十分有限，除了加強(qiáng)120接診中心工作人員對(duì)報(bào)警的急性心肌梗死癥狀患者提高警惕外，還應(yīng)當(dāng)提升接話員的溝通技巧，避免報(bào)警人員的贅述，從而造成接警時(shí)耗的延長(zhǎng)，在平時(shí)的工作中，也應(yīng)當(dāng)加強(qiáng)對(duì)院前接警工作的總結(jié)并加強(qiáng)對(duì)群眾的宣傳普及，使群眾掌握撥打120時(shí)應(yīng)當(dāng)提供哪些必要的信息，進(jìn)而減少接警時(shí)耗。在急診醫(yī)療服務(wù)中，鄭州本地急救站點(diǎn)主要承擔(dān)出診與院前急救兩個(gè)階段的工作，本研究結(jié)果顯示，兩組接受任務(wù)到出診時(shí)間、出診到抵達(dá)現(xiàn)場(chǎng)時(shí)間、現(xiàn)場(chǎng)到首次醫(yī)療接觸時(shí)間無差異，考慮可能是在社會(huì)及經(jīng)濟(jì)發(fā)展的過程中，鄭州本地機(jī)動(dòng)車的擁有量逐年攀升，復(fù)雜的交通狀況影響了出診車輛的行駛速度。所以應(yīng)當(dāng)加強(qiáng)對(duì)社會(huì)大眾的宣傳，強(qiáng)調(diào)和培養(yǎng)社會(huì)大眾對(duì)各種應(yīng)急車輛的禮讓意識(shí)，為應(yīng)急車輛開辟更便捷的通道。同時(shí)應(yīng)當(dāng)對(duì)駕駛救護(hù)車輛的司機(jī)人員加強(qiáng)地理知識(shí)、開車技巧、本地各時(shí)段路況特點(diǎn)的培訓(xùn)，以便選擇更為快速與便捷的路徑，用最快的速度抵達(dá)急救現(xiàn)場(chǎng)。試驗(yàn)組首次醫(yī)療接觸到首份心電圖時(shí)間短于對(duì)照組，優(yōu)化綠色通道前由醫(yī)生或護(hù)士進(jìn)行心電圖檢查，而優(yōu)化綠色通道后醫(yī)生根據(jù)癥狀懷疑急性心肌梗死時(shí)可讓通過培訓(xùn)的擔(dān)架員行心電圖檢查，此時(shí)醫(yī)生的查體及護(hù)士的吸氧、靜脈通路建立同時(shí)進(jìn)行，所以延遲時(shí)間可進(jìn)一步縮短。試驗(yàn)組首次醫(yī)療接觸到口服雙抗時(shí)間短于對(duì)照組，這可能與首次醫(yī)療接觸到首份心電圖時(shí)間縮短、急救醫(yī)護(hù)人員對(duì)盡早服用雙抗重要性的認(rèn)識(shí)提高有關(guān)。在既往多項(xiàng)研究中，早期心電圖診斷對(duì)減少延遲具有明顯的作用[17]。

3.3 院前院內(nèi)協(xié)調(diào)對(duì)延遲的影響 優(yōu)化綠色通道的措施還包括在救護(hù)車上對(duì)患者及家屬進(jìn)行心血管事件的初步告知以及通過電話的方式于院前轉(zhuǎn)運(yùn)階段與心血管?？漆t(yī)師(本院心血管醫(yī)師與導(dǎo)管介入醫(yī)師為同一人員)溝通患者病情并明確診斷，同時(shí)要求心血管?？漆t(yī)師于院內(nèi)搶救室待診。本研究結(jié)果顯示，盡管試驗(yàn)組急診醫(yī)師初步告知病情到患者理解時(shí)間、院前遠(yuǎn)程會(huì)診及導(dǎo)管室預(yù)激活時(shí)間長(zhǎng)于對(duì)照組，但這兩項(xiàng)處理措施均發(fā)生在院前轉(zhuǎn)運(yùn)階段，并不影響首次醫(yī)療接觸到球囊擴(kuò)張時(shí)間，且試驗(yàn)組待診?？漆t(yī)師二次告知并簽字時(shí)間短于對(duì)照組。而作為院內(nèi)延遲的主要原因之一的D2B[10]，試驗(yàn)組D2B短于對(duì)照組，兩組入導(dǎo)管室到球囊擴(kuò)張時(shí)間無差異，表明優(yōu)化綠色通道可有效避免患者抵達(dá)醫(yī)院后等待?？漆t(yī)師會(huì)診而造成的延遲，而在院前轉(zhuǎn)運(yùn)階段即與心血管病?？漆t(yī)師的會(huì)診溝通，還減少了心血管?？漆t(yī)師和患者及家屬再次溝通的時(shí)間，且通過對(duì)導(dǎo)管室的預(yù)激活減少了患者在搶救室內(nèi)的等待時(shí)間，進(jìn)而使院內(nèi)D2B明顯縮短，也使得院前急救和院內(nèi)診治從兩個(gè)單一的獨(dú)立系統(tǒng)被有效串聯(lián)成一條無縫連接通路，使患者的轉(zhuǎn)移及診治更加順暢與快捷，減少了患者的院內(nèi)延遲。在院前及院內(nèi)形成統(tǒng)一整體的前提下，國(guó)外學(xué)者還積極探索了以急診醫(yī)師直接激活導(dǎo)管室的做法，其試驗(yàn)結(jié)果也明確顯示這種做法可明顯減少院內(nèi)的延遲，為患者爭(zhēng)取更多的時(shí)間[8,11]。盡管通過急診醫(yī)師直接激活導(dǎo)管室的做法[18]僅有很少的概率使導(dǎo)管室誤激活，但就目前中國(guó)的醫(yī)療環(huán)境和實(shí)際情況而言，這種做法還不現(xiàn)實(shí)，隨著互聯(lián)網(wǎng)及移動(dòng)網(wǎng)絡(luò)的發(fā)展、電子化心電圖在本院的普及和今后生命體征檢測(cè)集成傳輸[19]等的發(fā)展，院前轉(zhuǎn)運(yùn)階段心血管?？漆t(yī)師遠(yuǎn)程監(jiān)控和會(huì)診后激活導(dǎo)管室的方式將可能被實(shí)現(xiàn)。

3.4 優(yōu)化綠色通道對(duì)預(yù)后的影響 本研究結(jié)果顯示，試驗(yàn)組TMP高于對(duì)照組，30 d病死率、心力衰竭發(fā)生率、心律失常發(fā)生率、心源性休克發(fā)生率、復(fù)流后再梗死發(fā)生率低于對(duì)照組，證明優(yōu)化采用綠色通道明顯降低了首次醫(yī)療接觸到球囊擴(kuò)張的延遲，進(jìn)而提升了STEMI患者的存活率，并可以降低不良心血管事件的發(fā)生率，這與既往研究結(jié)果相似[20]。

本研究存在的不足：(1)本研究患者僅來源于單一醫(yī)院，患者特點(diǎn)的廣泛性仍欠缺；(2)受研究時(shí)間限制，樣本量有限。

綜上所述，優(yōu)化綠色通道可縮短STEMI患者直接PCI延遲時(shí)間，并改善患者預(yù)后。急救調(diào)度系統(tǒng)的延遲在總延遲的比重很少，但整個(gè)院前急救過程均離不開急救調(diào)度系統(tǒng)的協(xié)調(diào)，建立與多部門協(xié)調(diào)的機(jī)制，充分開拓和運(yùn)用智能終端，才能減少STEMI患者的院前延遲及院內(nèi)延遲。院前轉(zhuǎn)運(yùn)階段的病情告知可減少院內(nèi)階段?？漆t(yī)師談話并簽字的時(shí)間。院前轉(zhuǎn)運(yùn)階段的病情告知和遠(yuǎn)程會(huì)診有助于形成院前急救與院內(nèi)急救的良好連接，從而降低總延遲時(shí)間。

作者貢獻(xiàn)：唐聚花進(jìn)行試驗(yàn)設(shè)計(jì)與實(shí)施、資料收集整理、撰寫論文并對(duì)文章負(fù)責(zé)；李娜、李芝明進(jìn)行試驗(yàn)實(shí)施、評(píng)估、資料收集；劉青進(jìn)行質(zhì)量控制及審校。

本文無利益沖突。

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(本文編輯：崔麗紅)

Effect of Application of Optimized Green Channel on ST-elevation Myocardial Infarction with Primary Percutaneous Coronary Intervention

TANG Ju-hua,LIU Qing,LI Na,LI Zhi-ming.

Department of Emergency,People′s Hospital of Zhengzhou,Zhengzhou 450000,China

TANG Ju-hua,Department of Emergency,People′s Hospital of Zhengzhou,Zhengzhou 450000,China;E-mail:wyjztjh@126.com

Background Cardiovascular disease threatens the health of people severely.About 16.7 million of people annually die from cardiovascular disease all around the world.In China,coronary atherosclerotic heart disease (CAHD) is also a major threat to the health of people,and about 700 thousand people die from CAHD each year.Of the treatment patterns for CAHD,primary percutaneous coronary intervention (PCI) is the main treatment for ST-elevation myocardial infarction (STEMI).Objective To analyze the effect of application of optimized green channel on how long the primary PCI for STEMI patients is delayed and on their prognosis,so as to provide a theoretical basis for clinical emergency treatment of STEMI.Methods 117 STEMI patients who underwent primary PCI through optimized green channel in People′s Hospital of Zhengzhou from 2013 to 2014 and met the inclusion criteria were selected as trial group.And 107 STEMI patients who performed primary PCI through non-optimized green channel in People′s Hospital of Zhengzhou from 2011 to 2012 and met the inclusion criteria were selected as control group.The general data of the patients,delay time〔time from the symptom onset in STEMI to calling the 120 medical emergency command center,time of the worker of 120 medical emergency command center answering the emergency call,time of first-aid station was assigned,time from accepting the task to starting to pay home visits,time from starting to pay home visits to arrival,time from arrival to the first medical contact,time from first medical contact to performing the first ECG,time between first medical contact and the patient orally prescribed two kinds of anticoagulant drugs (aspirin enteric-coated tablets 300 mg and clopidogrel 600 mg),duration between the patient was informed his conditions by the emergency physician initially and he understood it,time of pre-hospital remote consultation and pre-activation time of cardiac catheterization lab,duration between the patient or his relatives were informed twice by the specialist physician and he or they signed the signature before PCI,time from entering the cardiac catheterization lab to balloon dilation time,door-to-balloon (D2B) time〕,and the influencing factors for prognosis〔TIMI myocardial perfusion (TMP) grade,30-day mortality,incidence rate of serious adverse cardiac events after PCI (heart failure,arrhythmia,cardiac shock,reinfarction after reperfusion)〕 were recorded.Results Compared with control group,trial group had shorter time from the symptom onset in STEMI to calling the 120 medical emergency command center,time of the worker of 120 medical emergency command center answering the emergency call,time of first-aid station was assigned,time from first medical contact to performing the first ECG,time between first medical contact and the patient orally prescribed two kinds of anticoagulant drugs,duration between the patient or his relatives were informed twice by the specialist physician and he or they signed the signature before PCI and D2B time (P<0.05),but longer duration between the patient was informed his conditions by the emergency physician initially and he understood it,time of pre-hospital remote consultation and pre-activation time of cardiac catheterization lab (P<0.05).The differences in terms of time from accepting the task to starting to pay home visits,time from starting to pay home visits to arrival,time from arrival to the first medical contact,time from entering the cardiac catheterization lab to balloon dilation time between the two groups showed no statistical significance (P>0.05).Compared with control group,trial group had higher TMP grade,but lower incidence rates of 30-day mortality,heart failure,arrhythmia,cardiac shock,and reinfarction after reperfusion (P<0.05).Conclusion Application of optimized green channel can shorten the primary PCI delay time and improve the prognosis of patients with STEMI.

Myocardial infarction;Angioplasty,ballon,coronary;First aid;Green channel;Delay;Prognosis

450000 河南省鄭州市，鄭州人民醫(yī)院急診科

唐聚花，450000 河南省鄭州市，鄭州人民醫(yī)院急診科；E-mail：wyjztjh@126.com

R 542.22

A

10.3969/j.issn.1007-9572.2016.36.019

2016-04-16；

2016-10-17)