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目的评价首次医疗接触-梗死相关动脉开通(FMC2B)时间达标情况及影响因素。方法回顾性分析2013年7月至2014年9月于首都医科大学附属北京潞河医院行直接经皮冠状动脉介入治疗(PCI)的ST段抬高心肌梗死(STEMI)患者140例,根据《急性ST段抬高型心肌梗死诊断和治疗指南》的FMC2B时间建议,分为FMC2B达标组(59例)和FMC2B未达标组(81例),应用logistic回归分析影响FMC2B达标的因素。结果 140例患者中,首诊到非直接PCI医疗机构转运者58例,直接呼叫急救医疗服务系统到院31例,直接到潞河医院就诊51例。FMC2B中位时间为106.16 min,达标率为42.1%(59/140)。多因素logistic回归分析显示,首诊10 min内完成心电图(OR 5.61,95%CI 1.91~16.88,P=0.002)、常规工作时间就诊(OR 5.11,95%CI 1.88~13.85,P=0.001)、患者高中以上文化程度(OR 4.16,95%CI 1.53~11.34,P=0.005)和发病时意识到心脏问题(OR 2.58,95%CI 1.13~5.91)与FMC2B达标率高有关,转运PCI(OR 0.37,95%CI 0.15~0.92)则与FMC2B达标率低有关。结论 57.9%直接PCI的STEMI患者FMC2B时间没有达到指南建议标准,尤其是转运PCI患者。首诊心电图完成时间、就诊时间、转运PCI和患者的文化程度、发病时意识到心脏问题是FMC2B达标的独立预测因素。
Objective To evaluate the first medical exposure-infarction-related artery opening (FMC2B) time compliance and influencing factors. Methods A retrospective analysis of 140 patients with STEMI undergoing percutaneous coronary intervention (PCI) at Beijing Luhe Hospital Affiliated to Capital Medical University from July 2013 to September 2014 was performed retrospectively. According to " FMC2B guidelines for the diagnosis and treatment of ST-segment elevation myocardial infarction were divided into FMC2B compliance group (59 cases) and FMC2B non-compliance group (81 cases). Logistic regression analysis was used to analyze the factors influencing FMC2B compliance. Results Among the 140 patients, 58 cases were referred to non-direct PCI medical institutions directly and 31 cases were called directly to emergency medical service system, and 51 cases were directly referred to Luhe Hospital. FMC2B median time was 106.16 min, the compliance rate was 42.1% (59/140). Multivariate logistic regression analysis showed that the electrocardiogram (OR 5.61, 95% CI 1.91-16.88, P = 0.002) was completed within 10 min of the first visit, and the regular working hours were taken as the reference (OR 5.11,95% CI 1.88-13.85, P = 0.001) Patients with high school education (OR 4.16, 95% CI 1.53-11.34, P = 0.005) and heart disease at onset (OR 2.58, 95% CI 1.13-5.91) were associated with high FMC2B compliance rates, , 95% CI 0.15 ~ 0.92) and FMC2B compliance rate is low. Conclusions 57.9% of STEMI patients undergoing direct PCI did not meet the guideline recommendations for FMC2B timing, especially in patients with PCI. The time of the first diagnosis of ECG, the time of visiting the doctor, the degree of education of PCI and the patient’s level of education, and the onset of heart problems were independent predictors of FMC2B compliance.