CAJ | 학술논문

目的探讨在我国建立区域协同急性ST段抬高型心肌梗死(STEMI)救治网络系统(IRN-STEMI)的可行性及实施效果.方法以实时心电图传输技术为纽带,通过管理模式创新,以厦门市心脏中心为核心,协调120急救系统、其他具备直接经皮冠状动脉介入(PCI)能力的医院及部分基层医院等多家医疗单位创建厦门区域协同STEMI救治网络.总结IRN-STEMI运行1年来网络内所有医疗单位STEMI患者的救治情况,对厦门市心脏中心IRN-STEMI建立前(2012年3月16日至2013年3月15日,n=165)和建立后(2013年3月16日至2014年3月15日,n=256)两组患者基线特征,年平均首次医疗接触至球囊(FMC-to-B)时间、平均门至球囊时间(D-to-B)、平均住院天数、住院费用及住院期间病死率进行比较.结果 IRN-STEMI成立前网络内所有医疗单位收治STEMI患者245例,有221例(90.2％)接受再灌注治疗,其中直接PCI 185例(75.5％).IRN-STEMI成立后纳入STEMI患者343例,共321例(93.6％)接受再灌注治疗,其中直接PCI有290例(84.5％).与IRN-STEMI成立前比较,成立厦门市心脏中心后接受直接PCI的STEMI患者年平均FMC-to-B时间[(110.3±34.0)min比(137.9 ±58.5)min,P＜0.01]及年平均D-to-B时间[(76.5±33.0)min比(107.3±38.0)min,P＜0.01]较短,平均住院天数[(9.0±4.3)d比(9.7±4.8)d,P＞0.05]及住院期间病死率[3.1％(8/256)比3.0％(5/165),P＞0.05]差异无统计学意义,但平均住院费用明显减少[(51 398 ±22 100)元比(56 970 ±24593)元,P＜0.05].结论在国内由具有数家PCI能力的医院、120急救系统及基层网络医院共同建立区域性STEMI救治网络是可行的.通过IRN-STEMI可显著增加本地区接受直接PCI患者比例,明显缩短FMC-to-B及D-to-B时间,减少住院费用,是提升区域内STEMI救治水平的有效方法.
목적 탐토재아국건립구역협동급성ST단태고형심기경사(STEMI)구치망락계통(IRN-STEMI)적가행성급실시효과.방법 이실시심전도전수기술위뉴대,통과관리모식창신,이하문시심장중심위핵심,협조120급구계통、기타구비직접경피관상동맥개입(PCI)능력적의원급부분기층의원등다가의료단위창건하문구역협동STEMI구치망락.총결IRN-STEMI운행1년래망락내소유의료단위STEMI환자적구치정황,대하문시심장중심IRN-STEMI건립전(2012년3월16일지2013년3월15일,n=165)화건립후(2013년3월16일지2014년3월15일,n=256)량조환자기선특정,년평균수차의료접촉지구낭(FMC-to-B)시간、평균문지구낭시간(D-to-B)、평균주원천수、주원비용급주원기간병사솔진행비교.결과 IRN-STEMI성립전망락내소유의료단위수치STEMI환자245례,유221례(90.2％)접수재관주치료,기중직접PCI 185례(75.5％).IRN-STEMI성립후납입STEMI환자343례,공321례(93.6％)접수재관주치료,기중직접PCI유290례(84.5％).여IRN-STEMI성립전비교,성립하문시심장중심후접수직접PCI적STEMI환자년평균FMC-to-B시간[(110.3±34.0)min비(137.9 ±58.5)min,P＜0.01]급년평균D-to-B시간[(76.5±33.0)min비(107.3±38.0)min,P＜0.01]교단,평균주원천수[(9.0±4.3)d비(9.7±4.8)d,P＞0.05]급주원기간병사솔[3.1％(8/256)비3.0％(5/165),P＞0.05]차이무통계학의의,단평균주원비용명현감소[(51 398 ±22 100)원비(56 970 ±24593)원,P＜0.05].결론 재국내유구유수가PCI능력적의원、120급구계통급기층망락의원공동건립구역성STEMI구치망락시가행적.통과IRN-STEMI가현저증가본지구접수직접PCI환자비례,명현축단FMC-to-B급D-to-B시간,감소주원비용,시제승구역내STEMI구치수평적유효방법.
Objective To investigate the feasibility of establishing an integrated regional network for ST-segment elevation myocardial infarction (STEMI) care in China and evaluate the implementation effect of this network.Methods Based on real-time electrocardiogram transmission technology,we established an integrated regional network for STEMI care (IRN-STEMI) with Xiamen Heart Center as the core center,120Emergency Systems,PCI-capable hospitals and other community health units as core elements of this network.Reperfusion treatment data of Xiamen Heart Center including the number of patients receiving primary percutaneous coronary intervention (PCI),the mean first medical contact to balloon (FMC-to-B)time,the mean door to balloon (D-to-B) time,the mean length of hospital stay,the mean medical cost and in-hospital mortality were compared before (n =165) and at 1 year after the built-up of IRN-STEMI (n =343).Results Compared to pre-IRN-STEMI era,primary PCI ratio (84.5％ (290/343) vs.75.5％(185/245)) were significantly increased post establishment of IRN-STEMI within the network(P =0.06).STEMI patients admitted in Xiamen Heart Center was significantly increased from 165 to 256,the annual mean FMC-to-B time ((110.3 ± 34.0) min vs.(137.9 ± 58.5) min,P ＜ 0.01) and D-to-B ((76.5 ±33.0) min vs.(107.3 ± 38.0) min,P ＜ 0.01),as well as the mean medical cost were significantly decreased ((51 398±22 100)RMB vs.(56 970 ± 24 593)RMB,P ＜ 0.05),while the mean length of hospital stay ((9.0 ± 4.3) d vs.(9.7 ± 4.8) d,P ＞ 0.05) and in-hospital mortality (3.1％ (8/256) vs.3.0％ (5/165),P ＞ 0.05) remained unchanged before and after the setting of IRN-STEMI in Xiamen Heart Center.Conclusion Establishment of an integrated regional network system for STEMI patients in China is feasible.With collaboration of qualified heart center,EMS and PCI-capable and non-PCI capable local hospitals,establishment of IRN-STEMI effectively increased the ratio of primary PCI for STEMI patients,it also significantly shortened the FMC-to-B and D-to-B time,decreased mean medical cost,thus,the regional IRN-STEMI network might be an effective working system for improving the medical care for STEMI patients.