摘要
目的探讨网络心电会诊中心对首诊于不具备急诊经皮冠状动脉介入治疗（percutaneous coronaryintervention，PCI）能力的医院急性sT段抬高性心肌梗死（ST—segmentelevation myocardial infarction，STEMI）患者再灌注时间及实施效果评价。方法将本院网络心电会诊中心与全市50余家基层卫生院通过互联网络连接起来，建立县域、区域协同救治网络，通过培训使基层卫生院能够识别可疑为STEMI的患者，实时将心电图通过该平台传送至我院，胸痛中心确认后及时启动相关院前及院内救治流程。以区域协同救治网络运行前12个月（n=36）作为运行前组，与运行后12个月（n=42）作为运行后组，比较运行前后两组STEMI患者首次医疗接触到球囊扩张时间（firstmedical contact to balloon opening time，FMC—to—B）时间、进门到球囊扩张时间（door to balloon openingtime，D—to—B）、平均住院天数及再灌注治疗住院期间病死率。结果通过建设网络心电会诊中心，STEMI患者FMC—to—B（P=0．000）、D—to—B较运行前组缩短（P=0．000），平均住院天数也减少（P=0．000），而住院期间病死率比较差异无统计学意义（P=0．775）。结论在沿海经济发达的县域城市，建立STEMI区域协同救治网络体系是可行的，可以显著缩短首诊于非PCI医院STEMI患者再灌注时间，减少住院天数。
Objective To investigate reperfusion therapy time and to evaluate the implementation effect of patients with acute ST - segment elevation myocardial infarction （STEMI） who seek their first treatment in hospital without percutaneous coronary intervention （PCI） ability through Network ECG Consultation Center. Methods The hospital established a county -level regional collaborative rescue network through the platform of Network ECG Consultation Center to connect more than 50 grassroots health centers in the city. The hospital gave training to grassroots health centers to help them identify suspicious patients with STEMI, so that they could immediately send the ECG through the platform to the chest pain center in real time. The chest pain center launches relevant pre - hospital and in - hospital procedures in a timely manner after confirming the diagnosis. Twelve months before the operation of regional collaboration rescue network （ n = 36 ） was regarded as the pre - operation group. The FMC - to - B time, the average D - to - B time, the average length of hospital stay and the case fatality rate in hospital after the implementation of the reperfusion therapy of STEMI patients of the pre - operation group were compared with those of STEMI patients twelve months after the operation （ n = 42）. Results The establishment of Network ECG Consultation Center significantly reduced FMC - to - B time （ P = 0.000 ）, D - to - B time （ P = 0.000 ） and the average length of hospital stay （ P = 0. 000 ） in STEMI patients when compared to the pre - operation group; differences in mortality during hospitalization were not statistically significant （P = 0. 775 ）. Conclusion It is feasible to establish STEMI regional collaborative rescue network system in the county - level economically developed coastal cities at county -level, because it could significantly shortenthe reperfusion time and the length of hospital stay of STEMI patients who seek their first treatment in non - PCI hospitals.
出处
《中国急救医学》
CAS
CSCD
北大核心
2015年第9期827-831,共5页
Chinese Journal of Critical Care Medicine
基金
浙江省卫生适宜技术成果转化计划项目（2012ZHB014）
余姚市科技计划项目（2012Y02）
