| Objective: This study aimed at optimizing hospital comprehensive emergency process line for direct coronary intervention(percutaneous coronary intervention,PCI)of acute ST segment elevation myocardial infarction(ST-segment elevation myocardial infarction,STEMI)in patients with treatment effect.In addition,it was used to explore the significance of optimizing the hospital's comprehensive emergency procedures for STEMI patients,analyze the main factors affecting the hospital's comprehensive emergency procedures and improve measures,find the most important time nodes that affect the results in the treatment and provide theoretical guidance and suggestions for further improving the hospital's comprehensive emergency procedures.Methods: From July 2017 to March 2018,92 STEMI patients who underwent emergency PCI and met the inclusion criteria in the affiliated hospital of Qingdao university during the routine procedure were selected to form the pre-improvement group.The improved group was composed of 87 STEMI patients who underwent direct PCI and met the inclusion criteria after optimizing the comprehensive emergency treatment process under the background of the establishment of chest pain center in our hospital from April,2018 to December,2018.This study will be D to B is divided into the following six time nodes:an introduction to electrocardiogram(ECG)time(node 1),electrocardiogram(ECG)-primary diagnosis time nodes(2),the preliminary diagnosis-signed informed consent form time node(3),signed informed consent-international activation time nodes(4),the international activation-international time nodes(5),into the international time-balloon expansion(8)node.This study also includes international time-began to(6)node,began to puncture time-balloon expansion time nodes(7),two groups of blood-myocardial enzyme nodes(9),the preliminary diagnosis results time-double time nodes(10),hospitalization days,3 months Major adverse cardiovascular events(Major adverse cardiovascular events,MACE)and other important indicators.MACE mainly includes recurrent myocardial infarction,arrhythmia,cardiogenic shock and heart failure,node 8 is the sum of node 6 and node 7.Measurement data conforming to normal distribution in general baseline data and time nodes were expressed as(MSE),and two independent sample t tests were used for comparison between the two groups.The measurement data conforming to the non-normal distribution were expressed as(median,Q),and the rank sum test was used for comparison between the two groups.Counting data were compared by chi-square test(the sample size was small,chi-square test was used if necessary).P <0.05 was considered statistically significant in all the above studies.Results: The results showed that there was no statistically significant difference in general data between the improved group and the improved group(P > 0.05).The time of node 1,node 2,node 3,node 4,node 5,node 9,node 10 and d-to-b in the improved group was shorter than that in the improved group,and the difference between the two groups was statistically significant(P < 0.05).There was no significant difference in node 6,node7 and node 8 between the two groups(P > 0.05).The 3-month overall incidence of adverse cardiovascular events in the improved group was significantly lower than that in the former group,and the difference between the two groups was statistically significant(P <0.05).Node 3,node 4 and node 8 in the improved group did not meet the international standard for average time,and the remaining time met the standard.The results showed that there was a positive correlation between node 2 and D to B,rs = 0.233,P < 0.05;there was a positive correlation between node 3 and D to B,rs = 0.873,P < 0.01;there was a positive correlation between node 4 and D to B,rs = 0.653,P < 0.01;there was a positive correlation between node 5 and D to B,rs = 0.293,P < 0.01;the results of the improved group showed that there was a positive correlation between node 1 and D to B There was a positive correlation between node 3 and D to B,rs = 0.549,P < 0.01;there was a positive correlation between node 4 and D to B,rs = 0.270,P < 0.05;there was a positive correlation between node 5 and D to B,rs = 0.245,P < 0.05.Conclusion 1.D to B time was significantly shortened by optimizing the comprehensive emergency procedures in the hospital,resulting in a significant reduction in the overall incidence of cardiovascular adverse events after 3 months for STEMI patients.2.We have played an obvious role in the optimization of comprehensive first aid process by improving measures,such as ECG registration first,admission at zero cost,direct preoperative talk with the receiving physician,increase the number of activated catheter room staff,chest pain outpatient nurse into the catheter room,which has significantly shortened the D to B time.The use of POCT detection plays an important role in the rapid diagnosis of diseases.3.There are still some deficiencies in the improvement measures,and we should further improve the skills of talking with patients after the diagnosis is made clear,optimize the process of activating the catheter room,and speed up the preoperative preparation and operation time after patients enter the catheter room 4.The correlation between node 3 and D to B was the strongest in both the pre improvement group and the post improvement group,suggesting that the interval from the initial diagnosis of doctors to the signing of informed consent had the greatest impact on the time of the whole process. |
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