床旁快速检测对急性冠脉综合征诊断和预后影响.docVIP

床旁快速检测对急性冠脉综合征诊断和预后影响 【摘要】目的 对比床旁快速检测与传统实验室方法检测心肌损伤标志物对急性冠脉综合征（ACS）的诊断及预后的影响。方法 回顾性分析2006年1月1日至2010年6月30日首都医科大学附属北京朝阳医院急诊科收治已确诊的3467例急性冠脉综合征的患者，记录患者的年龄、性别、既往病史和吸烟史等基本人口资料，以及心肌损伤标志物（CTNI CKMB MYO）、D二聚体、NTproBNP、心脏彩超EF等实验室指标，采用统计学方法比较应用床旁快速检测与实验室检测心肌损伤标志物的患者，在急诊滞留时间（急诊就诊到接受介入或保守治疗之间用时）、入院到住院期间的心血管事件（心衰、室颤、脑血管病）的发生率和28 d病死率的不同。结果 床旁快速检测组的急诊滞留时间、心血管事件发生率和28 d病死率均低于常规实验室检测组（P=0.000），且急诊滞留时间越长，早期肌红蛋白和D二聚体测定值越高，EF测定值越低， 28 d死亡风险越高。结论 床旁快速检测比常规实验室检测能缩短ACS患者的急诊滞留时间，降低心血管事件发生率并能明显改善预后。【关键词】急性冠脉综合征；床旁快速检测；心肌损伤标志物；预后Comparison of point-of-care testing and laboratory testing of myocardial damage markers in the diagnosis and prognosis of acute coronary syndrome YANG Jun， LI Chun-sheng. Department of Emergency， Chaoyang Hospital， Affiliated to Capital Medical University， Beijing 100020， ChinaCorresponding author：LI Chun-sheng，Email：lcscyyy@163.com【Abstract】Objective To compare the point-of-care testing （POCT） and laboratory testing of myocardial damage markers in the diagnosis and prognosis of acute coronary syndrome （ACS）. Methods A total of 3467 patients with ACS who were treated in the Emergency Department Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 1， 2006 and June 30， 2010 were retrospectively reviewed. The patient demographics （age， sex， past medical history and smoking history） and laboratory testing results （myocardial damage markers， D-dimer， NTproBNP， and ejection fraction [EF]） were analyzed. The patients who received POCT or laboratory testing of myocardial damage markers were compared with regard to emergency department stay （i.e.， the time from the emergency visit to interventional or conservative treatment）， cardiovascular events during hospitalization （congestive heart failure， ventricular fibrillation， and cerebrovascular disease）， and 28-day mortality rate. Results The emergency department stay， incidence of a cardiovascular event， and 28-day mortality in the POCT group were all lower than that in the laboratory testing gr