向定成急性心肌梗死的再灌注治疗优化策略__培训课件.ppt

* Greatest emphasis is to be placed on the delivery of reperfusion therapy to the individual patient as rapidly as possible. * * This case showed us a typical timeline of a transferred STEMI patient. EMS was called until 5hours late after chest pain onset. The patient was sent to a community hospital by EMS after 21min and stayed there for nearly 2 hours but without thrombolytic therapy. 9 hours late from symptom-onset, he was transferred to PCI hospital. 55min later, the balloon was inflated. If refer to D2B, 55min is very good I think, but FMC-to-B is 280mins and symptom-to-b is delayed to 601mins. So we should pay more attention to prehospital works but not merely in-hospital green channel. So how to get the target? We established a standardized CPC model by developing a rescue network of CPC. With the founding of CPC, our service for the acute chest pain patients extends to the pre-hospital, connecting seamlessly with pre-hospital and in-hospital. * After inspected the running process, we can divide these CPCs into two models. One is in-hospital green channel model, which try to develop a rapid response flowsheet after the STEMI patients were admitted. D2B or D2N was the major evaluating target. And the another is standardized CPC model, which based on the inhospital green channel, pay more attention to the prehospital works. Besides D2B, FMC2B and Symptom-onset-to-B are the more important targets. * From CPACS study, Clinical Pathway Investigation of Acute coronary syndrome, which is a ACS registry in the cities of China, we found the time of symptom-onset-to-door were 5hours in grade 2 hospitals and 8h in grade 3 hospitals. It is great delay before the patients come to hodpital. * So how to improve this situation? If you just want to shorten D2B, you will develop in-hospital green channel. If you want to shorten FMC-to-B, you have to do more than in-hospital green channel, to train the community hospitals and develop a rapid transfer mechanism are necessary