de Belder Mark A, Ludman Peter F, McLenachan James M, Weston Clive F M, Cunningham David, Lazaridis Emmanuel N, Gray Huon H
The James Cook University Hospital, Middlesbrough, United Kingdom.
EuroIntervention. 2014 Aug;10 Suppl T:T96-T104. doi: 10.4244/EIJV10STA15.
The UK had previously established a comprehensive strategy for in-hospital nurse-led thrombolysis for patients with ST-elevation myocardial infarction, with a growing use of pre-hospital thrombolysis by paramedical staff in the ambulance services. The National Infarct Angioplasty Project was sponsored by the government and examined the introduction of primary percutaneous coronary angioplasty (PPCI) in a variety of urban, rural and mixed communities. The project found that PPCI could be delivered within acceptable timelines, would be cost-effective, and could be delivered to the majority of the population. A project was therefore undertaken in England to transform services. There has been a rapid change and by 2012/13 over 95% of eligible patients received PPCI. Survival of patients with STEMI has improved over time and length of stay in hospital halved. However, nearly a quarter of STEMI patients do not receive reperfusion therapy (often because of late presentation) and additional work is needed to minimise delays to treatment. There are unexplained differences between regions in numbers of PPCI procedures per million population, and there is also variance between centres in the proportion of patients who are in shock or on a ventilator. Additional research is needed to ensure a consistent approach for these sick patients, who might have the most to gain from early treatment. The national audit programmes have been instrumental in measuring the changes in strategies, monitoring performance and highlighting the associated improvements in outcomes. A new risk model is being developed to allow a more comprehensive comparison of outcomes in different hospitals.
英国此前已为ST段抬高型心肌梗死患者制定了一项由护士主导的院内溶栓综合策略，同时救护服务中的医护人员对院前溶栓的使用也越来越多。国家梗死血管成形术项目由政府资助，研究了在各种城市、农村和混合社区引入直接经皮冠状动脉介入治疗（PPCI）的情况。该项目发现，PPCI能够在可接受的时间范围内实施，具有成本效益，并且能够覆盖大多数人群。因此，英国开展了一个项目来转变服务。变化迅速，到2012/13年度，超过95%的符合条件的患者接受了PPCI。STEMI患者的生存率随时间推移有所提高，住院时间减半。然而，近四分之一的STEMI患者未接受再灌注治疗（通常是因为就诊较晚），需要开展更多工作以尽量减少治疗延误。每百万人口中PPCI手术数量在不同地区之间存在无法解释的差异，各中心在休克或使用呼吸机的患者比例方面也存在差异。需要开展更多研究，以确保对这些可能从早期治疗中获益最大的重症患者采取一致的治疗方法。国家审计项目有助于衡量策略变化、监测绩效并突出相关的预后改善情况。正在开发一种新的风险模型，以便更全面地比较不同医院的治疗结果。
