中国ST段抬高型心肌梗死患者急救医疗服务应用情况及对治疗的影响:中国急性心肌梗死(CAMI)注册研究
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摘要
目的:调查中国ST段抬高型心肌梗死(STEMI)患者急救医疗服务(EMS)的应用情况以及对治疗的影响。方法:入选中国急性心肌梗死(CAMI)注册研究2013年1月1日至2014年10月1日期间107家医院收治的13 549例STEMI患者,分为EMS组2 015例和自行来院组11 534例进行分析。结果:仅2 015例(14.9%)患者呼叫救护车就诊。与自行来院组相比,EMS组接受再灌注治疗的比例较高(64.9%vs 52.9%,P<0.001),从症状发作到医院的中位时间较短(170min vs 240 min,P<0.0001),到达医院至溶栓时间(D2N)较短(47 min vs 53 min,P=0.003),但是门-球时间(即到达医院至球囊扩张时间)相似(106 min vs 108 min,P=0.932)。多因素Logistic回归分析显示,未使用EMS的独立预测因素是农村居民和家中症状发作,而应用EMS的预测因素是非前壁心肌梗死、持续胸痛、严重呼吸困难或晕厥、院前心脏骤停、Killip心功能分级> 2、收缩压<100mmHg(1 mmHg=0.133 kPa)、超重/肥胖以及至省级医院就诊。结论:中国STEMI患者应用EMS的比例仅15%左右。应用EMS的患者从症状发作到医院就诊时间较短,接受再灌注的比例较高,但门-球时间未缩短。中国应加强公众教育,鼓励胸痛患者使用EMS,以及加强EMS和医院的衔接。
Objectives: The current study aims to explore the use and the effect of emergency medical services(EMS) in patients with ST elevation myocardial infarction(STEMI).Methods: An observational analysis was performed in 13 549 patients with STEMI, who were documented in China Acute Myocardial Infarction(CAMI) Registry and treated in 107 hospitals between January 1 st, 2013 and Oct 1 st, 2014. According to the way of arriving at the hospital, all patients were divided into EMS group and self-transport group.Results: Only 2015 patients(14.9%) were transported through EMS. Compared with self-transport, EMS-transport was associated with a higher rate of reperfusion therapy(64.9% vs 52.9%, P<0.001), shorter delays in symptom-onset-toarrival time(median, 170 min vs 240 min, P<0.0001) and door-to-needle time(median, 47 min vs 53 min, P=0.003), but not significantly shorter door-to-balloon time(median, 106 min vs 108 min, P=0.932). Multivariate logistic analysis revealed that the negative independent predictors of EMS transport were rural residents and symptom onset at home, while the positive independent predictors were non-anterior wall infarction, consistent chest pain, severe dyspnea or syncope, prehospital cardiac arrest, Killip > 2, SBP < 100 mmHg, overweight/obesity, and presentation to province-level hospital. Conclusions: EMS care for STEMI is greatly underused in China. EMS transportation is associated with reduction in symptom-onset-to-arrival time and higher rate of reperfusion, but not substantial reduction in treatment delays. Targeted efforts are needed to promote EMS use when chest pain occurs and set up a local STEMI network focusing on organization of care among EMS and hospitals in China.
Objectives: The current study aims to explore the use and the effect of emergency medical services(EMS) in patients with ST elevation myocardial infarction(STEMI).Methods: An observational analysis was performed in 13 549 patients with STEMI, who were documented in China Acute Myocardial Infarction(CAMI) Registry and treated in 107 hospitals between January 1 st, 2013 and Oct 1 st, 2014. According to the way of arriving at the hospital, all patients were divided into EMS group and self-transport group.Results: Only 2015 patients(14.9%) were transported through EMS. Compared with self-transport, EMS-transport was associated with a higher rate of reperfusion therapy(64.9% vs 52.9%, P<0.001), shorter delays in symptom-onset-toarrival time(median, 170 min vs 240 min, P<0.0001) and door-to-needle time(median, 47 min vs 53 min, P=0.003), but not significantly shorter door-to-balloon time(median, 106 min vs 108 min, P=0.932). Multivariate logistic analysis revealed that the negative independent predictors of EMS transport were rural residents and symptom onset at home, while the positive independent predictors were non-anterior wall infarction, consistent chest pain, severe dyspnea or syncope, prehospital cardiac arrest, Killip > 2, SBP < 100 mmHg, overweight/obesity, and presentation to province-level hospital. Conclusions: EMS care for STEMI is greatly underused in China. EMS transportation is associated with reduction in symptom-onset-to-arrival time and higher rate of reperfusion, but not substantial reduction in treatment delays. Targeted efforts are needed to promote EMS use when chest pain occurs and set up a local STEMI network focusing on organization of care among EMS and hospitals in China.
引文
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[33]Zhang QT,Hu DY,Yang JG,et al.Public knowledge of heart attack symptoms in Beijing residents[J].Chin Med J(Engl),2007,120(18):1587-1591.
[34]Hung KK,Cheung CS,Rainer TH,et al.EMS systems in China[J].Resuscitation,2009,80(7):732-735.DOI:10.1016/j.resuscitation.2009.04.016.
[35]Thomas TL,Clem KJ.Emergency medical services in China[J].Acad Emerg Med,2008,6(28):150-155.DOI:10.1111/j.1553-2712.1999.tb01054.xek.
[36]Wu Y,Zhang Y,Li YQ,et al.Factors associated with the extent of care-seeking delay for patients with acute myocardial infarction in Beijing[J].Chin Med J(Engl),2004,117(12):1772-1777.
[37]Thuresson M,Jarl?v MB,Lindahl B,et al.Thoughts,actions,and factors associated with prehospital delay in patients with acute coronary syndrome[J].Heart Lung,2007,36(6):398-409.DOI:10.1016/j.hrtlng.2007.02.001.
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