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目的观察院前12导联心电图对急性ST段抬高心肌梗死(STEMI)患者进门至再灌注时间的影响。方法多中心现况调查2006年1～12月期间就诊于北京市19所医院并接受再灌注治疗的急性STEMI患者。根据有无院前心电图分为有心电图组和无心电图组。结果 635例患者中,接受直接经皮冠脉介入治疗(PPCI)者506例(79.7%),其中有心电图者211例(41.7%),无心电图者295例(58.3%);接受溶栓者129例(20.3%),其中有心电图者46例(35.7%),无心电图者83例(64.3%)。院前心电图可显著缩短进门-球囊扩张时间(中位数,120 min比150 min;P<0.01),而对进门-溶栓时间(中位数,74min比93min;P=0.168)无影响。有心电图组进门90min内完成球囊扩张的比例显著高于无心电图组(24.6%比15.9%,P=0.017)。无论接受何种再灌注治疗,院前心电图对住院病死率无影响。结论院前心电图可显著缩短STEMI患者的进门-球囊扩张时间。应进一步提高院前心电图完成率。
Objective To observe the effect of 12-lead electrocardiogram in front of hospital on the time from the portal to reperfusion of acute ST-segment elevation myocardial infarction (STEMI). Methods Multi-center status investigation Acute STEMI patients were treated in 19 hospitals in Beijing from January to December 2006 for reperfusion. According to whether or not pre-hospital ECG is divided into ECG group and no ECG group. Results Of the 635 patients, 506 (79.7%) were treated with direct percutaneous coronary intervention (PPCI), 211 (41.7%) with electrocardiogram and 295 (58.3%) without electrocardiogram; 129 cases (20.3%), including 46 cases of electrocardiogram (35.7%), 83 cases without electrocardiogram (64.3%). Prehospital electrocardiogram significantly shortened the entry-to-balloon dilation time (median, 120 min vs 150 min; P <0.01), but had no effect on the time to portal-thrombolysis (median, 74 min vs 93 min; P = 0.168) . There was a significant increase in balloon dilation within 90 min of entry of the ECG group compared with no ECG (24.6% vs 15.9%, P = 0.017). No matter what kind of reperfusion treatment, pre-hospital ECG had no effect on in-hospital mortality. Conclusion Prehospital electrocardiogram can significantly shorten the time of entry-balloon dilatation of STEMI patients. Should further improve the pre-hospital ECG completion rate.