| Objective:(1)To analyze the factors associated with delayed door-to-balloon time(DTB)in STEMI patients undergoing PCI,and to find independent risk factors for DTB delay and to provide a clinical reference for reducing the delay time.(2)To construct a home-community-hospital synergy management plan for the treatment of acute coronary syndrome(ACS)and initially verify its feasibility and treatment effect for patients with acute coronary syndrome.(3)To improve the ability of self-care and self-care of the people,and provide clinical practice basis for shortening the time of first medical contact and that of DTB of STEMI patients.Methods:(1)Analysis of the factors related to the delay in treatment time of STEMI patients162 STEMI patients at a grade III A general hospital in Zhenjiang,Jiangsu Province from January 2017 to December 2017 are selected as the sample subjects.Inclusion criteria: a)in line with Acute ST Segment Elevated Myocardial Infarction(STEMI)Diagnosis and Treatment Guidelines issued in 2010 in China;b)aged above 18 years;c)Emergency line PCI.Exclusion criteria: a)patients who has died or performed CPR;b)patients whose blood vessels are not successfully opened with PCI;and c)patients with incomplete data records.Finally,information of the 121 study subjects who meet the inclusion criteria are collected(age,gender,past medical history,the way of hospitalization,admission time,bypass emergency,admission consciousness,heart rate,breathing,blood pressure,Killip grade,symptoms to first medical contact time,admission-first ecardiogram time,hospitalization-blood pumping time,door-to-drug time,first electrocardiogram-decision PCI time,decision PCI-consent time,informed consent-start ingesting catheter room),and the independent risk factors for DTB delay in patients with acute ST segment elevated myocardial infarction are discussed through single-factor analysis and multi-factor logistic regression analysis of 121 study subjects who meet the inclusion criteria.(2)Building a "family-community-hospital" collaborative treatment of STEMI According to the results of the above-mentioned analysis of factors related to the delay time of DTB in STEMI patients in 2017 in our region,I have optimized and perfected the rescue process from three aspects: home,community and hospital,and have formulated treatment and care measures that could shorten the time of DTB,while making reference to the 2015 China ACS Clinical Practice Guidelines,the 2017 European Society of Cardiology STEMI Diagnosis and Treatment Guidelines,and the 2018 Standardized Treatment of Elderly(≥75 years)Acute Coronary Syndrome Patients in China and related literature,and have initially constructed a home-community-hospital coordinated rescue program for acute coronary syndrome.(3)Application of "family-community-hospital" collaborative treatment of STEMI Using a quasi-experimental study method,82 STEMI patients have been selected who had attended the emergency department of a tertiary level A general hospital from January to June2019 and had received community or hospital training,and 63 STEMI patients have been included as an intervention group according to the inclusion criteria.A collaborative treatment plan has been adopted for salvage care.83 cases of STEMI patients attending the emergency department of a tertiary level A general hospital from January to June 2018 have been selected,and 61 cases of STEMI patients have been included as a control group according to the inclusion criteria,and routine salvage procedures have been used for salvage care.Compare PCI acceptance rates for symptom onset to first medical contact(FMC)time,admission first ECG completion time,admission-blood draw time,outpatient medication time,first ECG-decision PCI time,decision PCI-informed consent time,informed consent-initiated catheterization time,DTB time,symptom onset to balloon dilation time,in-hospital morbidity and mortality rate,in-hospital days,total in-hospital medical costs,unplanned all-cause readmission rate within 30 d,and PCI acceptance rates for the 2 groups.Results:(1)Analysis of the relevant factors of delay in treatment time for STEMI patients Of the 162 STEMI patients,121 patients have had PCI and meet the inclusion criteria.Among these,there are 30 cases of DTB above 90 min,accounting for 24.79 per cent.The results of a single-factor analysis show that the history of hypertension,the history of diabetes,the manner of admission,the time of first medical contact with symptoms,the time of the first drug,the first electrocardiogram-the decision of PCI time,the decision of PCI-informed consent time,informed consent-the initiation of the catheter chamber 8 variables are statistically significant(P 0.05).The results of logistic regression analysis of 8 variables of statistical significance show that hypertension,admission patterns,first ECG to Determining PCI Time,determining PCI-informed consent time are independent risk factors for STEMI patients with DTB above90 min.(2)Construction of a "home-community-hospital" collaborative treatment of STEMI Health management files of high-risk groups of regional acute coronary syndrome are established through screening and research,personalized health education both online and offline through multi-channel are established based on the unite of home,the Internet information transmission technology and referral process between the community,emergency centers and chest pain centers are established and improved,and the emergency pre-screening triage process and different rescue process for patients with chest pain are optimized to build a "home-community-hospital" collaborative treatment of acute coronary syndrome program.(3)Application of "Home-Community-Hospital" Synergy Treatment of STEMI(1)The proportion of PCI received in the control group is 73.49%,the rate of PCI acceptance in the intervention group is 76.83%,the patient mortality rate is 8.43% in the control group,the mortality rate is 8.43% in the intervention group,the mortality rate is 2.44%,and the difference,P>0.05,is not statistically significant.(2)Among the study subject of 124 patients who have received routine emergency PCI,in both the control group and the intervention group,factors are compared including the way patients are admitted to hospital,the symptoms appeared-the first medical contact time,the first ECG time in hospital,the decision PCI-informed consent time,informed consent-the start catheter room time,the DTB time,the symptom appearance-the balloon expansion time,the average number of hospital days,the hospitalization cost.Differences between the above 9variables,<0.05,are statistically significant.(3)There are 10 patients in the 30 d control group who have been re-admitted to hospital unplanned,and the non-planned readmission rate within 30 d is 12.05%.There are 3 patients in the 30 d intervention group who have been re-admitted to hospital unplanned,and the non-planned all-cause re-hospitalization rate within 30 d is 3.66%.Through statistical analysis,P<0.05,the difference is statistically significant.Conclusions:The “ Home-Community-Hospital ” Collaborative Management of Acute ST-segment Elevation Myocardial Infarction is based on the single and independent risk factors for delayed management of STEMI patients in the region,and is based on the latest guidelines and literature,with a view to reducing the delay time for both patient and staff factors.With specialist nurses’ early screening as a starting point,the program teaches disease-related knowledge and skills based on the unite of home and constantly improve the community and inter-hospital referral,evacuation,bypass emergency,pre-screening triage,rescue cooperation and other linking process through Internet technology.It not only gives full play to the role of specialist nurses,but also mobilizes the enthusiasm of home members,so that STEMI patients can get the most timely and optimal treatment.After the preliminary application of the program,the results show that the mode of "home-community-hospital" coordinated treatment for acute coronary syndrome can shorten the seating time for STEMI patient and the symptoms episode to balloon dilation time,as well as reduce the average number of hospital days,the cost of hospitalization and the 30 d’s non-planned all-cause readmission rate.In the meanwhile,health education and other secondary prevention are carried out for the targeted region’s ACS high-risk groups,and public knowledge of disease are also improved,so that hospitals get social benefits. |
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