扩大一个区域性ST段升高心肌梗塞系统的扩展到整个州
James G Jollis1, Hussein R Al-Khalidi, Lisa Monk
1Duke Clinical Research Institute, Duke University, Durham, NC 27710, USA. james.jollis@duke.edu
Circulation
|June 6, 2012
概括
协调护理计划显著减少了所有患者ST段升高心肌梗塞 (STEMI) 治疗的延迟,特别是那些在医院之间转移的患者. 这提高了再输血率,降低了死亡率,并将快速的STEMI护理作为标准. 关键词:STEMI治疗,再输,医院间转移,死亡率.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健系统 医疗保健系统
背景情况:
- 国家指导方针建议在ST段升高心肌梗塞 (STEMI) 时及时进行冠状动脉再输血.
- 治疗延迟是常见的,特别是对于需要跨院转移的患者.
- 需要有效的战略来克服这些障碍.
研究的目的:
- 评估全州协调护理计划对STEMI治疗的及时性和结果的影响.
- 评估对STEMI患者的再输血率和门到设备时间的改善.
- 为了确定及时治疗对患者死亡率的影响.
主要方法:
- 119家北卡罗来纳州医院实施了协调的STEMI治疗计划.
- 收集了6841名STEMI患者 (2008年7月至2009年12月) 的数据,这些患者直接或通过医院间转移.
- 分析了再注射率的变化,门到设备的时间,以及计划实施前后的死亡率.
主要成果:
- 没有接受再输血的患者比例从5.4%降至4.0% (P=0.04).
- 医院间转移患者 (P=0.0008) 和直接呈现者 (P<0.001) 的门到设备的时间显著改善.
- 在指南目标范围内治疗的患者的死亡率较低 (2.2%),而超过目标的患者 (5.7%,P<0.001).
结论:
- 全州区域协调有效地建立了快速的STEMI诊断和治疗作为标准的护理.
- 协调方法改善了治疗时间和降低死亡率,无论医疗机构或地点如何.
- 该模型展示了全系统策略在优化急性心肌梗塞护理方面的成功.
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