CAJ | 학술논문

目的探讨建立区域协同救治网络对首诊于不具备急诊经皮冠状动脉介入治疗(PCI)能力医院的急性ST段抬高型心肌梗死(STEMI)患者再灌注时间及近期预后的影响.方法广州总医院胸痛中心通过12导联心电图远程实时传输监护系统将PCI中心与30余家非PCI医院(网络医院)连接起来建立区域协同救治网络,通过培训使网络医院执行与PCI医院相同的流程.选取首诊于3家网络医院的STEMI患者为研究对象,以区域协同救治网络运行前20个月(2009年8月至2011年3月)的数据作为对照,观察运行后20个月(2011年4月至2012年11月)STEMI患者平均进门到溶栓(D-to-N)时间、进门到球囊扩张(D-to-B)时间、D-to-N达标率、D-to-B达标率和首次医疗接触到球囊扩张(FMC-to-B)时间以及再灌注治疗后1年病死率的变化.结果区域协同救治网络运行后STEMI患者平均D-to-N时间明显低于运行前[(28 ±9) min比(71±62) min,P＜0.05],D-to-N达标率高于运行前[74％(26/35)比11％ (2/18),P＜0.05];补救PCI组和转运PCI组患者FMC-to-B和D-to-B时间均低于相应的亚组(P均＜0.05),转运PCI组患者再灌注治疗后1年的病死率低于运行前[7.0％ (10/142)比15.1％ (8/53),P＜0.05].结论建立区域协同救治网络可以显著缩短首诊于非PCI医院的STEMI患者的再灌注时间,提高达标率并降低患者近期病死率.
목적 탐토건립구역협동구치망락대수진우불구비급진경피관상동맥개입치료(PCI)능력의원적급성ST단태고형심기경사(STEMI)환자재관주시간급근기예후적영향.방법 엄주총의원흉통중심통과12도련심전도원정실시전수감호계통장PCI중심여30여가비PCI의원(망락의원)련접기래건립구역협동구치망락,통과배훈사망락의원집행여PCI의원상동적류정.선취수진우3가망락의원적STEMI환자위연구대상,이구역협동구치망락운행전20개월(2009년8월지2011년3월)적수거작위대조,관찰운행후20개월(2011년4월지2012년11월)STEMI환자평균진문도용전(D-to-N)시간、진문도구낭확장(D-to-B)시간、D-to-N체표솔、D-to-B체표솔화수차의료접촉도구낭확장(FMC-to-B)시간이급재관주치료후1년병사솔적변화.결과 구역협동구치망락운행후STEMI환자평균D-to-N시간명현저우운행전[(28 ±9) min비(71±62) min,P＜0.05],D-to-N체표솔고우운행전[74％(26/35)비11％ (2/18),P＜0.05];보구PCI조화전운PCI조환자FMC-to-B화D-to-B시간균저우상응적아조(P균＜0.05),전운PCI조환자재관주치료후1년적병사솔저우운행전[7.0％ (10/142)비15.1％ (8/53),P＜0.05].결론 건립구역협동구치망락가이현저축단수진우비PCI의원적STEMI환자적재관주시간,제고체표솔병강저환자근기병사솔.
Objective To investigate the impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction (STEMI) admitting to community hospitals without percutaneous coronary intervention (PCI) capacity (Non-PCI hospital).Methods A regional collaborative network was developed,consisting of a PCI center and over 30 Non-PCI hospitals and connected by a tele-transmitted real-time 12-lead electrocardiogram system.This system enables the cardiologists on duty in PCI center to help the physicians in the Non-PCI hospitals (network hospital) to confirm the diagnosis and choose a reperfusion strategy for STEMI patients.All cardiologists in PCI center and physicians in Non-PCI hospitals were trained to follow the flowchart of reperfusion strategies for STEMI patients to shorten the reperfusion time.The mean time from door of Non-PCI hospital to needle of thrombolysis (D-to-N),the mean time from door of PCI center to balloon (D-to-B) and the mean time from the first medical contact to balloon (FMC-to-B) and the 1-year mortality were compared between the 20 months before and the 20 months after establishment of the regional collaborative network for patients with the first medical contact in three network hospitals.Results After establishment of the regional collaborative network,the mean D-to-N time was significantly shortened from (71 ± 62)min to (28 ± 9)min (P ＜ 0.05),the rate of D-to-N below 30 min was increased from 11％ (2/18) to 74％ (26/35) ; the mean FMC-to-B and the mean D-to-B time were remarkably reduced in both complementary percutaneous coronary intervention and transfer percutaneous coronary intervention patients (all P ＜ 0.05),the 1-year mortality post reperfusion was reduced from 15.1％ (8/53) to 7.0％ (10/142) (P ＜ 0.05).Conclusion The establishment of regional collaborative network could shorten the perfusion time and reduce the 1-year mortality for STEMI patients presenting to Non-PCI hospitals.