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目的分析580例急性心肌梗死(AMI)患者院前延误时间分布及心肌梗死后不同时间段的死亡情况。方法回顾性分析2004年3月至2006年3月北京安贞医院抢救中心急诊室和急诊重症监护室收治的 AMI 患者580例,其中男性428例,女性152例,平均年龄(60.7±12.9)岁。将记录的就诊时间与发病时间的时间差作为院前延误时间(PDT)。根据 PDT 不同分为7个时间段:即1～30 min,31～60 min,61～120 min,121～240 min,241～360 min,361～720 min,>720 min。统计PDT 分布,计算各时间段心室颤动(室颤)发生率、复苏成功率、病死率,并对不同时间段死亡原因相关因素进行分析。结果 580例 AMI 患者 PDT 中位数时间为130 min。接受溶栓治疗122例(21.0%),急诊 PCI 及冠状动脉搭桥术(CABG)266例(45.9%),其他药物对症治疗192例(33.1%);比较三组 PDT,溶栓组[(104.5±2.3)min]和PCI/CABG组[(119.1±2.3)min]均低于其他药物治疗组[(290.9±3.4)min,P<0.05]。发生室颤46例(7.9%),其中 PDT≤30 min 24.4%(11/45),31～60 min 7.7%(8/104),61～120 min 10.3%(14/136),121～240 min 6.6%(8/121),241～360 min 1.9%(1/54),361～720 min 3.3%(2/61),>720 min 3.4%(2/59);复苏成功率71.7%(33/46),总病死率5.3%。年龄(OR=1.047,P=0.004)、糖尿病(OR=2.159,P=0.02)和 PDT(OR=2.159,JP=0.023)是影响患者预后的独立相关因素。结论缩短 PDT,及早进入治疗程序,挽救濒死心肌,对预防室颤、猝死发生,降低病死率至关重要。
OBJECTIVE: To analyze the distribution of pre-hospital delay and the death at different time points after myocardial infarction in 580 patients with acute myocardial infarction (AMI). Methods A retrospective analysis was performed on 580 AMI patients admitted to the Emergency Center and Emergency Intensive Care Unit of Anzhen Hospital, Beijing from March 2004 to March 2006. There were 428 males and 152 females with an average age of 60.7 ± 12.9 years . The record of the time of treatment and the time of onset as the pre-hospital delay time (PDT). According to the different PDT is divided into seven time periods: 1 ~ 30 min, 31 ~ 60 min, 61 ~ 120 min, 121 ~ 240 min, 241 ~ 360 min, 361 ~ 720 min,> 720 min. The distribution of PDT was calculated and the incidence of ventricular fibrillation (VF), the success rate of recovery and mortality were calculated. The related factors of death in different time periods were analyzed. Results The median PDT of 580 AMI patients was 130 min. Thrombolytic therapy in 122 patients (21.0%), emergency PCI and coronary artery bypass grafting (CABG) in 266 patients (45.9%) and other drugs symptomatic treatment in 192 patients (33.1% ± 2.3) min and PCI / CABG group (119.1 ± 2.3) min were significantly lower than those in other groups [(290.9 ± 3.4) min, P <0.05]. 46 patients (7.9%) experienced ventricular fibrillation, PDT≤30 min 24.4% (11/45), 31-60 min 7.7% (8/104), 61-120 min 10.3% (14/136), 121-240 , the rate of successful recovery was 71.7% (2/59), the rate of recovery was 71.7% (2/59) 33/46) with a total case fatality rate of 5.3%. Age (OR = 1.047, P = 0.004), diabetes (OR = 2.159, P = 0.02) and PDT (OR = 2.159, JP = 0.023) were independent prognostic factors. CONCLUSIONS: Shortening PDT, entering early treatment procedures and saving dying myocardium are essential for preventing VF, sudden death and reducing mortality.