论文部分内容阅读
目的:探讨医疗支援模式对当地急性心肌梗死诊治及预后的影响。方法:复旦大学附属中山医院2010年3月起对云南省曲靖市富源县人民医院进行医疗对口支援活动,选择2010年3月—2014年4月富源县人民医院收治的103例急性心肌梗死患者,将2010年3月—2012年11月收治的51例患者分为A组,2012年12月—2014年4月收治的52例患者分为B组。对2个时间段内患者的治疗策略、住院天数、用药情况及预后进行比较。结果:103例急性心肌梗死患者中,男性吸烟比例显著高于女性(P<0.05)。只有21例ST段抬高型急性心肌梗死患者在发病12 h之内就诊。B组ST段抬高型急性心肌梗死患者溶栓率高于A组(P<0.05)。57例患者获得随访,其中只有约1/3的患者接受了后续的冠脉造影和PCI术。B组住院期间二磷酸腺苷(ADP)受体拮抗剂(氯吡格雷)的使用率高于A组(P<0.05)。出院后ADP受体拮抗剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、氯吡格雷等药物的使用率均明显下降,但2组差异无统计学意义。2组各终点事件发生率差异均无统计学意义(P>0.05)。结论:医疗支援模式提高了住院期间心肌梗死的诊断率和治疗规范性。但住院前的就诊时间仍没有缩短,出院后二级预防治疗不规范,说明除了加强住院期间的医疗诊治能力外,仍需加大对患者的健康教育和基层医护人员的培训,并加强区域合作。
Objective: To investigate the effect of medical support on the diagnosis, treatment and prognosis of local acute myocardial infarction. Methods: Zhongshan Hospital Affiliated to Fudan University started to provide medical support to Fuyuan People’s Hospital of Qujing City, Yunnan Province in March 2010 and selected 103 patients with acute myocardial infarction who were treated in Fuyuan County People’s Hospital from March 2010 to April 2014, Fifty-one patients admitted from March 2010 to November 2012 were divided into group A, and 52 patients admitted from December 2012 to April 2014 were divided into group B. The treatment strategy, hospitalization days, medication status and prognosis of patients in two time periods were compared. Results: Among 103 acute myocardial infarction patients, the smoking rate of men was significantly higher than that of women (P <0.05). Only 21 cases of ST-elevation acute myocardial infarction patients within 12 hours of onset of treatment. In group B, the thrombolysis rate in patients with ST-elevation acute myocardial infarction was higher than that in group A (P <0.05). Fifty-seven patients were followed up and only about one-third of patients underwent coronary angiography and PCI. The use of ADP receptor antagonist (clopidogrel) in group B during hospitalization was higher than that in group A (P <0.05). Discharge ADP receptor antagonists, β-blockers, angiotensin converting enzyme inhibitors (ACEI), clopidogrel and other drugs were significantly decreased the use of the rate, but the two groups showed no significant difference. There was no significant difference in the incidence of each end point between the two groups (P> 0.05). Conclusion: The medical support model improves the diagnosis and treatment of myocardial infarction during hospitalization. However, the pre-hospital visit time is still not shortened, and the secondary prevention and treatment after discharge is not standardized. This shows that in addition to strengthening medical diagnosis and treatment during hospitalization, health education and training of primary health care workers are still required and regional cooperation should be strengthened .