【摘要】 目的在新型冠状病毒肺炎疫情防控形势下,探讨救治策略改变对急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者救治的有效性和安全性。方法选取河北医科大学第二医院心内科在新型冠状病毒肺炎(COVID-19)防控形势期间收治的急性STEMI患者34例纳入研究组,新型冠状病毒肺炎防控常态化期间收治的急性STEMI患者62例纳入对照组,比较两组一般临床资料、再灌注治疗情况[发病至首次医疗接触时间(Onset-to-FMC)、首次医疗接触时间至导丝通过(FMC to wire, FMC-to-W)时间、心肌梗死溶栓治疗试验(thrombolysis in myocardial infarction, TIMI)血流分级、总缺血时间(从症状发作到导丝通过病变的时间)、首次医疗接触时间至开始溶栓(FMC to needle of thrombolysis,FMC-to-N)时间、溶栓再通比例、24 h内接受再灌注治疗比例、支架植入率、住院天数等]、主要不良心血管事件(major adverse cardiac events,MACE)、出血事件、心功能相关指标。结果研究组Onset-to-FMC时间和总缺血时间明显延长(P<0.05),接受静脉溶栓治疗比例增高,而接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,pPCI)的患者比例降低(P<0.05),支架置入比例、住院天数低于对照组(P<0.05);两组心功能指标比较,研究组入院时血清BNP高于对照组(P=0.042)。结论在新型冠状病毒肺炎疫情防控形势下,STEMI患者Onset-to-FMC时间和总缺血时间明显延长,接受静脉溶栓治疗比例增高,接受PPCI的患者比例减少,但出血风险及MACE没有增加。救治策略改变保证了STEMI患者的有效再灌注,没有对STEMI患者救治有效性和安全性产生不利影响。更多还原

【Abstract】 Objective To analyze the effectiveness and safety of optimized treatment approach for acute ST-segment elevation myocardial infarction(STEMI) patients under the situation of prevention and control of COVID-19.Methods Consecutive 34 acute STEMI patients admitted to the Department of Cardiology of the Second Hospital of Hebei Medical University under COVID-19 prevention and control were included in study group, and 62 acute STEMI patients admitted during COVID-19 prevention and control period were included in control group. The general clinical data, reperfusion treatment status(time from system onset to first medical contact, onset-to-FMC), time from first medical contact to wire(FMC-to-W), thrombolysis in myocardial infarction(TIMI) blood flow classification, total ischemic time(time from symptom onset to guide wire passing through the lesion), the time from the first medical contact to the start of thrombolysis(FMC to needle of thrombolysis, FMC-to-N), thrombolysis recanalization rate, the rate of reperfusion therapy within 24 hours, stent implantation rate, hospitalization time, etc), major adverse cardiac events(MACEs) were recorded.Results Compared with the control group, Onset-to-FMC time and total ischemic time in the study group were significantly prolonged(P<0.05), and the proportion of receiving intravenous thrombolytic therapy was significantly increased, while the proportion of undergoing direct percutaneous coronary intervention(PCI) was significantly decreased(P<0.05), and the proportion of stent implantation and the hospitalization time were significantly decreased(P<0.05). The cardiac function indexes, the serum BNP at admission in the study group were significantly increased(P=0.042).Conclusion Under the situation of prevention and control of COVID-19, Onset-to-FMC time and total ischemic time of STEMI patients were significantly prolonged, the proportion of receiving intravenous thrombolytic therapy increased, while the proportion of receiving direct PCI decreased, but bleeding risk and MACEs have no increase. The study suggested that the optimized treatment approach ensures the effective reperfusion for STEMI patients, without adversely affecting the effectiveness and safety for the treatment of STEMI patients.更多还原