Abstract: Background Cardiovascular diseases are a serious threat to public health, with approximately 16.7 million deaths worldwide each year. In China, coronary atherosclerotic heart disease (CAHD) is also the leading cardiovascular disease endangering public health, causing about 700,000 deaths annually. Among the treatment methods for CAHD, primary percutaneous coronary intervention (PCI) is the main treatment for ST-elevation myocardial infarction (STEMI). Objective To analyze the effect of optimized green channel on the delay time of primary PCI and prognosis in STEMI patients, so as to provide a theoretical basis for clinical emergency treatment of STEMI. Methods A total of 117 STEMI patients who underwent primary PCI through the optimized green channel in Zhengzhou People's Hospital from 2013 to 2014 and met the inclusion criteria were selected as the trial group. Retrospectively, 107 STEMI patients who underwent primary PCI through the pre-optimized green channel in Zhengzhou People's Hospital from 2011 to 2012 and met the inclusion criteria were selected as the control group. General data of patients, delay time 〔time from symptom onset to calling for help, 120 alarm response time, first-aid station assignment time, time from task acceptance to dispatch, time from dispatch to on-site arrival, time from on-site arrival to first medical contact, time from first medical contact to first electrocardiogram (ECG), time from first medical contact to oral administration of dual antiplatelet drugs (300 mg aspirin enteric-coated tablets and 600 mg clopidogrel), time from initial condition notification by emergency physicians to patient understanding, pre-hospital teleconsultation and catheterization laboratory pre-activation time, time from secondary notification and signature by consulting specialists, time from catheterization laboratory entry to balloon dilation, door-to-balloon (D2B) time〕, and prognostic factors 〔TIMI myocardial perfusion (TMP) grade, 30-day mortality, incidence of major adverse cardiovascular events after PCI (heart failure, arrhythmia, cardiogenic shock, reinfarction after reperfusion)〕 were recorded. Results Compared with the control group, the trial group had shorter time from symptom onset to calling for help, 120 alarm response time, first-aid station assignment time, time from first medical contact to first ECG, time from first medical contact to oral dual antiplatelet drugs, time from secondary notification and signature by consulting specialists, and D2B time, while longer time from initial condition notification by emergency physicians to patient understanding, pre-hospital teleconsultation and catheterization laboratory pre-activation time (P＜0.05). There were no significant differences in time from task acceptance to dispatch, time from dispatch to on-site arrival, time from on-site arrival to first medical contact, and time from catheterization laboratory entry to balloon dilation between the two groups (P＞0.05). The trial group had higher TMP grade, and lower 30-day mortality, incidence of heart failure, arrhythmia, cardiogenic shock, and reinfarction after reperfusion than the control group (P＜0.05). Conclusion The optimized green channel can shorten the delay time of primary PCI and improve the prognosis of STEMI patients.

Key words: Myocardial infarction, Angioplasty, balloon, coronary, First aid, Green channel, Delay, Prognosis

摘要： 背景 心血管疾病是严重威胁广大人民群众健康的疾病，每年全世界约有1670万人死于心血管疾病。在我国，冠状动脉粥样硬化性心脏病（CAHD）也是威胁人民群众健康的首要心血管疾病，每年约有70万人死于CAHD。CAHD的治疗方法中，针对ST段抬高型心肌梗死（STEMI）的治疗手段主要是直接经皮冠状动脉介入治疗（PCI）。目的 分析优化绿色通道对STEMI患者直接PCI延迟时间及预后的影响，为临床工作者对STEMI急诊救治工作提供理论依据。方法 选取2013—2014年于郑州人民医院通过优化后绿色通道行直接PCI的符合纳入标准的STEMI患者117例为试验组。回顾性选取2011—2012年于郑州人民医院通过优化前绿色通道行直接PCI的符合纳入标准的STEMI患者107例为对照组。记录患者一般资料、延迟时间〔患者出现症状到报警时间、120接警时间、指派急救站时间、接受任务到出诊时间、出诊到抵达现场时间、现场到首次医疗接触时间、首次医疗接触到首份心电图时间、首次医疗接触到口服双抗药物（阿司匹林肠溶片300 mg、氯吡格雷600 mg）时间、急诊医师初步告知病情到患者理解时间、院前远程会诊及导管室预激活时间、待诊专科医师二次告知并签字时间、入导管室到球囊扩张时间、进门到球囊扩张时间（D2B）〕、预后因素〔TIMI心肌灌注分级（TMP）、30 d病死率、PCI后严重不良心血管事件（心力衰竭、心律失常、心源性休克、复流后再梗死）发生率〕。结果 试验组患者出现症状到报警时间、120接警时间、指派急救站时间、首次医疗接触到首份心电图时间、首次医疗接触到口服双抗药物时间、待诊专科医师二次告知并签字时间、D2B短于对照组，急诊医师初步告知病情到患者理解时间、院前远程会诊及导管室预激活时间长于对照组（P＜0.05）；两组接受任务到出诊时间、出诊到抵达现场时间、现场到首次医疗接触时间、入导管室到球囊扩张时间比较，差异无统计学意义（P＞0.05）。试验组TMP高于对照组，30 d病死率、心力衰竭发生率、心律失常发生率、心源性休克发生率、复流后再梗死发生率低于对照组（P＜0.05）。结论 优化绿色通道可缩短STEMI患者直接PCI延迟时间，并改善患者预后。

关键词: 心肌梗死, 血管成形术, 气囊, 冠状动脉, 急救, 绿色通道, 延迟, 预后