Abstract:

Objective　To construct a cluster management model that shortens the time from first medical contact to balloon (FMC-to-B) in patients with acute myocardial infarction (AMI), and analyze its application value. Methods　By consulting relevant literatures and summarizing clinical work experiences, a cluster management model for shortening FMC-to-B time was constructed. A prospective randomized controlled study was conducted, selecting 121 AMI patients in Shangqiu First People's Hospital from January 2020 to January 2023 as the study subjects. The patients were divided into a control group and an observation group using the random number table method + sealed letter method. During the study period, the control group did not fall off, a total of 61 cases. There were 28 males and 33 females, aged 42-56 (50.30±4.50) years, Killip cardiac function classification: 32 cases of grade I and 27 cases of grade II, and routine nursing was used. In the observation group, 1 case fell off due to delayed percutaneous coronary intervention (PCI), a total of 59 cases. There were 35 males and 24 females, aged 42-56 (50.42±4.56) years, Killip cardiac function classification: 37 cases of grade I and 24 cases of grade II. On the basis of the control group, the cluster management mode of shortening FMC-to-B time was used to intervene, the main contents were to build a medical team and establish a shortening FMC-to-B time model. The clinical indicators, treatment, complications, economic indicators and nursing satisfaction were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　The AMI diagnosis time, FMC-to-B time, and catheter room activation time in the observation group were shorter than those in the control group [(582.61±10.36) s vs. (602.67±10.07) s, (110.61±9.48) min vs. (125.77±11.81) min, (19.85±3.94) min vs. (28.39±5.82) min], with statistically significant differences (t=10.758, 7.737, and 9.386, all P<0.05). The revascularization rate of infarction and survival rate in the observation group were higher than those in the control group [94.92% (56/59) vs. 83.61% (51/61), 93.22% (55/59) vs. 80.33% (49/61)], with statistically significant differences (χ²=3.971 and 4.314, both P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups [13.56% (8/59) vs. 18.03% (11/61)] (χ²=0.450, P>0.05). The hospitalization time of the observation group was shorter than that of the control group, and the hospitalization cost was lower than that of the control group [(8.95±1.84) d vs. (10.95±1.51) d, (39 503.25±600.36) yuan vs. (43 981.22±586.37) yuan], with statistically significant differences (t=6.519 and 41.335, both P<0.05). The nursing satisfaction of the observation group was higher than that of the control group, with a statistically significant difference (Z=2.003, P<0.05). Conclusion　The construction and application of a cluster management model for shortening the FMC-to-B time of AMI patients can effectively shorten the AMI diagnosis time, FMC-to-B time, catheter room activation time, and hospitalization time, improve the vascular recanalization and survival rates, reduce the hospitalization costs, and improve the patients' nursing satisfaction.

Key words:

Acute myocardial infarction, Cluster management, First medical contact to balloon time

摘要：

目的　构建缩短急性心肌梗死（AMI）患者首次接触医疗到球囊扩张（FMC-to-B）时间的集束化管理模式，并分析其应用价值。方法　通过查阅相关文献、总结临床工作经验，构建缩短FMC-to-B时间的集束化管理模式。采用前瞻性随机对照研究，选取2020年1月至2023年1月商丘市第一人民医院收治的121例AMI患者作为研究对象，采用随机数字表法+密封信法将患者分为对照组与观察组。研究期间对照组未有脱落，共61例；其中男28例，女33例；年龄42～56（50.30±4.50）岁；Killip心功能分级：Ⅰ级32例、Ⅱ级27例；采用常规护理。观察组因延迟实施经皮冠脉介入术（PCI）脱落1例，共59例；其中男35例，女24例；年龄42～56（50.42±4.56）岁；Killip心功能分级：Ⅰ级37例、Ⅱ级24例；在对照组基础上，采用缩短FMC-to-B时间的集束化管理模式干预，其主要内容有构建医护团队、建立缩短FMC-to-B时间模式等。比较两组患者临床指标、救治情况、并发症、经济指标以及护理满意度。采用独立样本t检验、χ²检验和秩和检验。结果　观察组患者确诊AMI时间、FMC-to-B时间及导管室激活时间均短于对照组［（582.61±10.36）s比（602.67±10.07）s、（110.61±9.48）min比（125.77±11.81）min、（19.85±3.94）min比（28.39±5.82）min］，差异均有统计学意义（t=10.758、7.737、9.386，均P<0.05）。观察组梗死血管再通率、存活率均高于对照组［94.92%（56/59）比83.61%（51/61）、93.22%（55/59）比80.33%（49/61）］，差异均有统计学意义（χ²=3.971、4.314，均P<0.05）。两组患者并发症总发生率比较［13.56%（8/59）比18.03%（11/61）］，差异无统计学意义（χ²=0.450，P>0.05）。观察组住院时间短于对照组、住院费用低于对照组［（8.95±1.84）d比（10.95±1.51）d、（39 503.25±600.36）元比（43 981.22±586.37）元］，差异均有统计学意义（t=6.519、41.335，均P<0.05）。观察组护理满意度高于对照组，差异有统计学意义（Z=2.003，P<0.05）。结论　缩短AMI患者FMC-to-B时间的集束化管理模式的构建及应用可以有效缩短确诊AMI时间、FMC-to-B时间、导管室激活时间及住院时间，提高血管再通率与存活率，减少住院费用，且能提高患者的护理满意度。

关键词:

急性心肌梗死, 集束化管理, 首次接触医疗到球囊扩张时间