CAJ | 학술논문

ST段抬高型心肌梗死%经皮冠状动脉介入术%首次医疗接触%首次医疗接触到球囊扩张%入门到球囊打开%急救医疗服务体系%胸痛中心%物联网 ST段抬高型心肌梗死%經皮冠狀動脈介入術%首次醫療接觸%首次醫療接觸到毬囊擴張%入門到毬囊打開%急救醫療服務體繫%胸痛中心%物聯網
ST단태고형심기경사%경피관상동맥개입술%수차의료접촉%수차의료접촉도구낭확장%입문도구낭타개%급구의료복무체계%흉통중심%물련망
ST-segment elevation myocardial infarction STEMI%Percutaneous coronary intervention%First medical contact%First medical contact to balloon%Door-to-balloon time%Emergency medical services system%Chest pain center%Internet of things

目的通过建立胸痛中心和运用现代物联网技术远程实时传输12导联心电图等监测数据,探讨对ST段抬高急性心肌梗死(STEMI)急诊介入治疗(PCI)时间的影响.方法选择STEMI急诊PCI患者435例,分为2010年组(98例)、2011年组(114例)和2012年组(223例),记录胸痛中心建立前后3年发病-首次医疗接触(FMC)、首次医疗接触-球囊打开(FMC2B)、入门-球囊打开(D2B)变化及和救治效果.用非正态计量资料中位数和四分位数间距描述,多组间比较采用秩和检验.结果患者发病-FMC 2010、2011和2012年组的中位时间分别为112、62、78 min,各年组间变化无统计学意义(P =0.368).2010、2011和2012年FMC2B的中位时间分别为287.0、313.5、421.8 min,组间比较差异无统计学意义(P=0.135).D2B中位时间分别为107、78、59 min,各年组间D2B时间比较差异具有统计学意义(P=0.000),通过各种途径转运来院的患者D2B均有明显的改善(P =0.008),但自行来院患者的D2B各年组未见改善(P=0.846).结论胸痛中心建立和胸痛急救物联网的应用能有效的缩短STEMI患者D2B的时间,但要缩短发病-再灌注时间还必须建立整个区域的胸痛救治体系和全社会的参与.
목적 통과건립흉통중심화운용현대물련망기술원정실시전수12도련심전도등감측수거,탐토대ST단태고급성심기경사(STEMI)급진개입치료(PCI)시간적영향.방법 선택STEMI급진PCI환자435례,분위2010년조(98례)、2011년조(114례)화2012년조(223례),기록흉통중심건립전후3년발병-수차의료접촉(FMC)、수차의료접촉-구낭타개(FMC2B)、입문-구낭타개(D2B)변화급화구치효과.용비정태계량자료중위수화사분위수간거묘술,다조간비교채용질화검험.결과 환자발병-FMC 2010、2011화2012년조적중위시간분별위112、62、78 min,각년조간변화무통계학의의(P =0.368).2010、2011화2012년FMC2B적중위시간분별위287.0、313.5、421.8 min,조간비교차이무통계학의의(P=0.135).D2B중위시간분별위107、78、59 min,각년조간D2B시간비교차이구유통계학의의(P=0.000),통과각충도경전운래원적환자D2B균유명현적개선(P =0.008),단자행래원환자적D2B각년조미견개선(P=0.846).결론 흉통중심건립화흉통급구물련망적응용능유효적축단STEMI환자D2B적시간,단요축단발병-재관주시간환필수건립정개구역적흉통구치체계화전사회적삼여.
Objective To study the efficiency of tele-consultation on Internet with transmitting realtime 12-lead ECG carried out by the Chest Pain Center evaluated by the length of time required for the emergency percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods A total of 435 STEMI patients treated by emergency PCI were divided into the group A (n =98,admitted in 2010),group B (n =114,admitted in 2011) and group C (n =223,admitted in 2012).Data were collected before (2010) and after establishment of the Chest Pain Center (2011 to 2012) including the length of time elapsed from onset of symptoms to the first medical contact (FMC),the length of time required from FMC to the intra-aortic balloon inflated (FMC-2B) and the length of time required from entering the gate of hospital to the intra-aortic balloon inflated (D-2B).Measure data were described with non-normal median and interquartile intervals.Comparisons were made among groups with rank sum test.Results The median time of D2B of three groups were 107,78 and 59 mins in groups A,B and C,respectively.The differences in D2B among three groups were significant (P =0.000).The time of the D2B was shortened significantly because of the patients transferred to the hospital with a variety of ways (P =0.008).However,the length of D2B time was not significantly changed (P =0.846) when patients came to the hospital all on themselves.The median times from symptom onset to FMC in the group A,group B and group C were 112,62 and 78 mins.and the differences among three groups were not statistically significant (P =0.368).The median times of FMC2B in three groups were 287.0,313.5 and 421.8 mins,respectively,and there were no significant differences (P =0.135).Conclusions The establishment of the Chest Pain Center and Internet of things can effectively shorten the duration of D2B in STEMI patients.However,the reduction of time length from the symptom onset to reperfusion must rely on the coordination between communities and health care system.