Gomes Renata, Rossi Renata, Lima Sónia, Carmo Pedro, Ferreira Rui, Menezes Isabel, Anjos Rui, Teixeira Ana, Rosa João, Matono José, Maciel Paula, Martins Maynone
Hospital de Santa Cruz -CHLO, Carnaxide, Portugal.
Rev Port Cardiol. 2010 Feb;29(2):181-91.
A telemedicine program was initiated in November 2000 between the Pediatric Cardiology Department of a tertiary care hospital in Lisbon and pediatricians and obstetricians from three remote Portuguese hospitals: two in mainland Portugal and one in the Azores. Images were transmitted by a telemedicine link over three integrated service digital network (ISDN) lines to a regional pediatric cardiology unit for interpretation by a consultant pediatric cardiologist.
We performed a retrospective review of all teleconsultations at our Department between November 2000 and December 2007. We analyzed the population (fetal, neonatal and pediatric), indications for teleconsultation, diagnoses, impact of the teleconsultation and medical management.
Over seven years, a total of 577 real-time teleconsultations were carried out in 500 patients, corresponding to 201 fetal exams (35%), 249 evaluations of newborns (43%) and 127 of children (22%). A total of 103 transmissions were urgent (18%). There were 364 positive diagnoses (63%) in 209 newborns (56%), 85 children (23%) and 71 fetuses (21%). Structural congenital heart disease was the most frequent diagnosis, complex in 95 patients. In all of the complex anomalies, the segmental arrangement and the main diagnosis were correctly assessed by telemedicine, with the exception of one case of a telemedicine diagnosis of atrial septal defect which was not subsequently confirmed. Nineteen patients required urgent transfer to Lisbon, while a medical team from our department traveled to the local hospitals and performed surgical ligation of a large patent ductus arteriosus in three premature newborns and a percutaneous atrioseptostomy in one newborn with transposition of the great arteries and severe desaturation unresponsive to prostaglandins, thus avoiding the transfer of unstable patients. The other patients were referred for follow-up in local clinics or for specialist consultation, either locally or at our hospital.
In our experience, real-time telemedicine with on-line echocardiography, conducted by a pediatric cardiologist, is an important tool in the diagnosis or exclusion of pediatric cardiovascular diseases in patients admitted to remote hospitals. It plays an important role in continuous medical training for the staff of those hospitals, especially in the field of pre-and post-natal echocardiography. Telemedicine has significant medical, economic and social benefits for patients, families and institutions in remote areas, particularly in the field of pediatric cardiology.
2000年11月，里斯本一家三级护理医院的儿科心脏病科与葡萄牙三家偏远医院的儿科医生和产科医生启动了一项远程医疗项目：两家位于葡萄牙大陆，一家位于亚速尔群岛。图像通过远程医疗链路经三条综合业务数字网（ISDN）线路传输至一个地区儿科心脏病科单元，由儿科心脏病学顾问进行解读。
我们对2000年11月至2007年12月期间我科所有的远程会诊进行了回顾性研究。我们分析了人群（胎儿、新生儿和儿童）、远程会诊的指征、诊断结果、远程会诊的影响以及医疗管理情况。
在七年时间里，共对500名患者进行了577次实时远程会诊，其中包括201次胎儿检查（35%）、249次新生儿评估（43%）和127次儿童评估（22%）。共有103次传输为紧急情况（18%）。在209名新生儿（56%）、85名儿童（23%）和71名胎儿（21%）中，共有364例确诊（63%）。结构性先天性心脏病是最常见的诊断结果，95例病情复杂。在所有复杂畸形病例中，除了一例远程医疗诊断的房间隔缺损后来未得到证实外，通过远程医疗正确评估了节段排列和主要诊断。19名患者需要紧急转至里斯本，而我科的一个医疗团队前往当地医院，为三名早产新生儿进行了大型动脉导管未闭的手术结扎，并为一名患有大动脉转位且对前列腺素无反应的严重低氧血症新生儿进行了经皮球囊房间隔造口术，从而避免了不稳定患者的转运。其他患者被转介至当地诊所进行随访，或在当地或我院进行专科会诊。
根据我们的经验，由儿科心脏病专家进行的在线超声心动图实时远程医疗，是诊断或排除偏远医院收治患者的儿科心血管疾病的重要工具。它在为这些医院的工作人员提供持续医学培训方面发挥着重要作用，尤其是在产前和产后超声心动图领域。远程医疗对偏远地区的患者、家庭和机构具有重大的医疗、经济和社会效益，尤其是在儿科心脏病学领域。
