| 引用本文： |
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张戟,魏毅东,彭文辉,等.临床路径优化对STEMI患者急诊PCI的影响和评价[J].同济大学学报（医学版）,2013,34(6):41-44. [点击复制]
- ZHANG Ji,WEI Yi-dong,PENG Wen-hui,et al.Clinical Pathways improve the management of acute ST-elevated myocardial infarction with emergent percutaneous coronary intervention[J].同济大学学报（医学版）,2013,34(6):41-44. [点击复制]
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| 摘要: |
| 目的通过启动院内ST段抬高心肌梗死（STEMI）患者救治的临床路径，探讨优化急诊经皮冠状动脉介入治疗（EPCI）流程对门－球囊（D to B）时间及STEMI患者预后的影响。方法根据美国心脏病学学A／美国心脏协会（ACC／AHA）、中国急性STEMI诊断和治疗指南制定临床路径并制作诊疗流程图，对2010年1月－2010年12月间本院心内科急性STEMI患者（A组）的诊治情况进行调查，收集数据，作为优化路径前资料；从2011年1月—2011年12月使用优化的临床路径对STEMI患者（B组）的诊治进行干预，将临床路径运用电子化病历，按临床路径的提示进行优化诊治。患者出院时将入选患者的相关数据进行收集记录，并在完成病例6个月随访后对数据进行分析，对临床路径进行质量控制及持续改进。结果STEMI患者经临床路径优化前后DtoB平均时间由99．8min缩短至89．4min，D to B时间达标比例由54．5％提高至71．5％（P〈0．05）；住院期间药物规范使用的比例β受体阻滞剂、ACEI／ARB及四联药物规范使用比例明显提高（P〈0．05）；住院期间死亡率由12．3％降低至6．1％，至出院后30d累计死亡率临床路径优化组仍有明显改善（P〈0．05）；主要不良心脏事件（MACE）发生率在住院期间、30d及180d均有明显改善（P〈0．05）。结论本研究通过临床路径的干预缩短了STEMI患者D to B时间，住院期间及出院后30天患者的死亡率明显下降。同时，使临床医生的医疗行为更接近指南的要求，使医疗资源的利用更加合理。 |
| 关键词: 心肌梗死 临床路径 门-球囊时间 经皮冠状动脉介入治疗 |
| DOI：10. 3969/j. issn1008-0392. 2013. 06. 009 |
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| 基金项目:国家自然科学基金（81070107） |
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| Clinical Pathways improve the management of acute ST-elevated myocardial infarction with emergent percutaneous coronary intervention |
| ZHANG Ji,WEI Yi-dong,PENG Wen-hui,SHEN Jian-ying,MING Qiang,XU Ya-wei |
| (Dept. of Cardiology, Tenth People＇s Hospital, Tongji University, Shanghai 200072, China) |
| Abstract: |
| Objective To investigate the effect of hydrogen sulfide on severe acute pancreatitis （SAP） in rats. Methods Wistar male rats were randomly divided into 4 groups： control group （n = 40）, SAP model group （ n = 40）, SAP ＋ NariS group （ n = 40 ） and SAP ＋ PAG group （ n = 40 ）. The acute pancreatitis model was induced by in injection of L-Arg in rats and according to the time after final injection, each group were further divided into 4 subgroups（ n = 10） ： 3,12,24 h and 36 h. The H2S and amylase levels in serum and cystathionine-γ-synthase（CSE） content in pancreatic tissue were measured;the histopathological changes of pancreatic tissue were examined. Results In the SAP ＋ NariS group, the serum amylase level was significantly elevated compared to SAP group; however there was no significant difference in CSE expression between NariS group and SAP group. Microscopically, the pancreatic tissue damage was more serious and the emerging of necrosis and lobular structural failure in SAP ＋ NariS was earlier than those in SAP group. Compared to SAP group, serum amylase, H2S content and tissue CSE content SAP ＋ PAG group were reduced significantly; pathological examination showed that the pancreatic tissue damage was significantly delayed, the bleeding and inflammatory cells infiltration significantly reduced and Grewal pancreas pathological damage assessment also demonstrated Conclusion Serum H2S level is positively correlated a significant difference with the SAP group. with tissue damage in severe acute pancreatitis of rats, and PAG can relieve the tissue damage of acute pancreatitls. |
| Key words: myocardial infarction clinical pathways door-to-balloon time percutaneous coronary intervention |
