您的位置:365医学网 >> 热点资讯 >> 正文

周胜华教授团队发表 “中国STEMI患者急诊PCI术治疗的‘节假日效应’”
作者:365编辑  
文章号:W125377  
2017/12/18 10:43:54    
文字大小:

  (365医学通讯社 报道)近日,中南大学湘雅二医院心血管内科周胜华教授团队在Journal of Geriatric Cardiology杂志上发表的题为“Effect of Chinese national holidays and weekends versus weekday admission on clinical outcomes in patients with STEMI undergoing primary PCI”的论文再次唤起了我国心血管同行对“STEMI直接PCI术的节假日效应” 的重视。该回顾性研究共入选了441例STEMI并接受直接PCI术的患者,其中129例患者在传统中国节假日或周末期间接受直接PCI术,312例患者在非节假日期间接受直接PCI术。研究结果显示在传统中国节假日或周末期间发生STEMI接受急诊PCI术的患者,治疗后院内不良事件发生率较非假节日期间更高,这一现象被称为急性心肌梗死的“节假日效应”。考虑到STEMI发病率高且患者基数大,即使是不良事件率轻度的增加,也能导致不良事件的大量增加。因此,探讨“节假日效应”的相关机制,对STEMI的诊治有一定指导意义。

  对于急性心梗的“节假日效应”,近年国外陆续有相关报道,但报道的结果并不一致。例如,Dasari等在2014年分析了美国急性心梗注册研究中的43,242 例STEMI患者发现,与正常工作时间入院的患者相比,节假日期间入院的STEMI患者院内死亡率显著增高13%。2015年Toshiaki等回顾性分析了日本急性心梗注册研究的111,200例STEMI患者亦得出相似结论。然而,2012年英国的一项回顾性研究入选了2, 571例STEMI行急诊PCI术的患者,结果显示节假日期间与正常工作时间入院的患者,在院内及2年随访期间临床效果无明显差异。此外,2013年Cubeddu等对HO RIZONS-AMI研究中的2,440例STEMI患者进行亚组分析发现节假日及夜间入院的患者血运重建时间会较正常工作时间入院者延迟,但是两组患者在院内和长期效果方面并无显著差异。

  值得一提的是,不同的国家,其“节假日效应”产生的原因不同,其对应的改进措施亦不相同。而就我们国内而言,有关急性心肌梗死 “节假日效应”的研究报道甚少。周胜华教授团队分析了5年的STEMI急诊PCI术病例后发现,国内急性心肌梗死“节假日效应”的产生主要是由于中国传统节假日或周末期间,患者的总缺血时间(症状发作至开通闭塞冠状动脉的时间)的延长所致。该研究发现节假日入院的STEMI患者的总缺血时间延长主要来自于院外的延迟。客观因素方面,在节假日特别是中国传统节日期间,外出旅游者的数量大量增加,可能由于交通更为拥挤或发病地点距离有PCI救治能力的医院更远等多种原因导致了院前延迟时间增加。患者对急性心梗的认知不够,出现相应症状时,未引起足够重视,一些老年患者往往想拖延至节后再去医院就诊等。

  针对研究中所发现的患者发病后就诊时间延误和就诊以后医院内的延误,从而导致传统中国节假日或周末期间入院的STEMI患者院内死亡率较高的现象。周胜华教授团队提出了如下应对措施:(1)完善院前急救系统以缩短STEMI转运至有PCI能力医院的时间;(2)积极开展社区教育,让患者及时发现并重视自身的症状,缩短症状发生至首次医疗接触时间;(3)强化专科医生的训练,严格遵循当前STEMI治疗指南,缩短患者首次医疗接触至PCI术开通闭塞冠状动脉的时间。这与目前国内提倡的“胸痛中心”的理念不谋而合。建立“胸痛中心”是最近为改善急性心梗的预后而提出的概念,即通过多学科(包括医疗急救系统、急诊科和心内科等)合作,提高急性心梗早期诊断和治疗的能力,最大限度地缩短早期救治时间,改善患者的临床预后并有效降低疾病负担。

  附件:文章摘要

  Abstract

  Background  Data  regarding the influence of weekends and Chinese national holiday’s admission on the outcomes of patients with ST-elevated myocardial infarction (STEMI) is lacking. This study sought to investigate the effect of Chinese national holidays and weekend admission on outcomes in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).

   Methods Patients presenting with STEMI within 12 h of symptom onset who underwent PPCI were retrospectively enrolled. The primary outcome of in-hospital mortality and major adverse cardiovascular events in patients presenting Chinese national holidays and weekends versus weekdays was evaluated.

  Results A total of 441 STEMI patients were enrolled in this study. Of these, 129 (29.3%) patients were admitted during Chinese national holidays and weekends and 312 (70.7%) during weekdays. Patients admitted during holidays and weekends were more likely to present with Killip class III-IV. Patients admitted during holidays and weekends experienced a significantly longer door-to-balloon time, symptom onset-to-door time as well as symptom onset-to-balloon time. The in-hospital mortality between patients presenting holidays and weekends versus weekdays was comparable. However, patients admitted during holidays and weekends have a significantly higher rate of in-hospital major adverse cardiovascular events. Multivariate analysis demonstrated that holidays and weekends admission was independently associated with adverse outcomes.

   Conclusions In China, STEMI patients undergoing PPCI during national holidays and weekends have worse in-hospital outcomes compared to those admitted during weekdays. These findings suggest that continuous efforts should be undertaken to enhance the Chinese healthcare system and to ensure that comparable outcomes are achieved for all STEMI patients regardlessof time of presentation.

转载请注明:内容转载自365医学网 
http://www.365nao.com
作者简介
365编辑
单位:365医学网
简介:  致力于医学学术服务   Devoted to medical science service
进入作者主页
该作者其他相关文章
免责条款隐私保护版权声明365医学网招聘RSS订阅投稿校园招聘
客服中心 4000680365 任老师:18631963501 孙老师:18963323483 刘老师:13306339682 service@365yixue.com 编辑部 editor@365yixue.com
心血管网 版权所有 © 365heart All Rights Reserved. 京ICP备12009013号-1 京卫网审[2013]第0056号 京公网安备110106006462号
互联网药品信息服务资格证书(京)-非经营性-2013-0035