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目的:多中心、前瞻性观察非正常工作时间对急性ST段抬高心肌梗死(STEMI)患者院内再灌注延迟的影响。方法:连续入选自2005年11月至2006年7月,在北京市19个医疗中心至急诊室就诊并接受再灌注的STEMI患者共297例。分为正常工作时间(A时间)和非正常工作时间(B时间)再灌注治疗组。分析与A时间再灌注治疗相比,B时间对进门-再灌注延迟的影响。结果:297例患者中,A时间再灌注治疗组120例(40．4%),其中38例患者接受溶栓治疗,82例患者接受急诊经皮冠状动脉介入治疗(PCI);B时间再灌注治疗组177例(59．6%),其中49例患者接受溶栓治疗,128例患者接受PCI治疗。在校正患者的其他临床因素后,B时间再灌注治疗组的进门-球囊扩张时间(D2B)中位数显著长于A时间再灌注治疗组(174．3min[95%可信区间(CI):172．8～176．2]比138．3min[95% CI:136．1～140．2];P＜0．01),B时间再灌注治疗组的进门-溶栓时间(D2N)中位数和A时间再灌注治疗组无显著差别(62．7min[95% CI:61．8～64．5]比59．8min[95% CI: 58．1～61．3];P=0．07)。结论:北京市在B时间接受PCI治疗的STEMI患者D2B时间延迟增加。
Objective: To evaluate the effect of abnormal working hours on the reperfusion delay in hospital after acute ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 297 consecutive STEMI patients were enrolled in this study from November 2005 to July 2006 in 19 medical centers in Beijing and received emergency reperfusion. Divided into normal working hours (A time) and abnormal working hours (B time) reperfusion treatment group. The effect of B on portal-reperfusion delay was analyzed in comparison with A-time reperfusion. RESULTS: Of the 297 patients, 120 (40.4%) were treated with time-A reperfusion, 38 of whom received thrombolysis and 82 received emergency percutaneous coronary intervention (PCI); B reperfusion Treatment group, 177 cases (59.6%), of which 49 patients received thrombolytic therapy, 128 patients received PCI. After adjusting for other clinical factors in patients, the median infantile-to-balloon dilatation time (D2B) in the B-time reperfusion group was significantly longer than in the A-time reperfusion group (174.3 min [95% confidence interval 172.8 ~ 176.2] than 138.3 min [95% CI: 136.1-140.2]; P <0.01). The median time to portal-thrombolysis time (D2N) There was no significant difference between the number and time A reperfusion groups (62.7 min [95% CI: 61.8-64.5] vs 59.8 min [95% CI: 58.1-61.3]; P = 0. 07). Conclusions: The time delay of D2B in STEMI patients in Beijing who received PCI at time B increased.