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目的分析不同时间就诊的ST段抬高型心肌梗死(STEMI)患者急诊直接经皮冠状动脉介入治疗(PPCI)对预后的影响。方法单中心回顾性研究。入选2011年7月-2014年5月就诊于解放军306医院行急诊经皮冠状动脉介入治疗(PPCI)且发病≤12h的STEMI患者共223例。按照就诊时间分为工作日工作时间组(8:00am~6:00pm)、工作日非工作时间组(6:00pm~8:00am)及周末、节假日组(周六、周日及法定节假日)。对3组就诊后的STEMI救治时间及各项可能影响预后的因素进行统计学分析,比较不同时间就诊是否对STEMI患者PPCI的预后产生影响。结果所有入选患者中,年龄(P=0.018)、高血压(P=0.005)及高脂血症(P=0.017)在临床基线资料比较中差异有统计学意义。进门-球囊扩张时间(DTB)、首次医疗接触-球囊扩张时间(FMCTB)、住院天数、院内死亡、院外(30d)死亡在三组中差异无统计学意义。Logistic回归分析非工作时间组及周末、节假日组院外(30d)死亡差异无统计学意义。Killip分级(P=0.006)、CKMB峰值(P=0.037)、住院天数(P=0.013)为院外(30d)死亡的独立预测因素。结论非工作时间及周末、节假日就诊与工作时间就诊的STEMI患者行急诊PPCI同样安全,不会增加急诊PPCI后死亡事件的发生。
Objective To analyze the effect of direct percutaneous coronary intervention (PPCI) on the prognosis of patients with STEMI treated at different times. Methods Single center retrospective study. A total of 223 STEMI patients who were admitted to the People’s Liberation Army 306 Hospital from July 2011 to May 2014 for emergency percutaneous coronary intervention (PPCI) with onset ≤12h were included. According to the treatment time is divided into working day working time group (8:00 am ~ 6:00 pm), working day non-working time group (6:00 pm ~ 8:00 am) and weekends and holidays group (Saturday, Sunday and legal holidays) . The time of STEMI treatment and the factors that may affect the prognosis of the three groups were statistically analyzed to compare whether the different time of treatment affects the prognosis of PPCI in STEMI patients. Results All of the selected patients had statistically significant differences in clinical baseline data between age (P = 0.018), hypertension (P = 0.005) and hyperlipidemia (P = 0.017). There were no significant differences among the three groups in the number of door-to-balloon dilatation time (DTB), initial medical contact-balloon dilatation time (FMCTB), length of hospital stay, hospital death, and death outside the hospital (30 d) Logistic regression analysis of non-working hours and weekend, holiday outside the hospital (30d), the difference was not statistically significant. Killip grading (P = 0.006), CKMB peak (P = 0.037), hospital stay (P = 0.013) were independent predictors of out-of-hospital (30-day) mortality. Conclusions Emergency PPCI is also safe for emergency STEMI patients during non-working hours and on weekends, holidays and working hours, and does not increase the incidence of death after emergency PPCI.