[ST段抬高型心肌梗死护理的区域综合网络建设]

[Integrated regional network construction for ST-segment elevation myocardial infarction care].

作者信息

Wang Bin, Wang Yan, Ye Tao, Xiao Guosheng, Chang He, Wen Hongmei, Chen Yuan, Lin Jiyi, Yang Lulin, Ye Jianhong, Huang Lei, Chen Lianfa, Cui Yong, Fan Changqing, Wu Yueping, Zheng Qiaoke

机构信息

Department of cardiology, Xiamen Heart Center, Xiamen 361003, China.

Email:

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Aug;42(8):650-4.

PMID:25388337

Abstract

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, 120 Emergency 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.

摘要

目的

探讨在中国建立ST段抬高型心肌梗死（STEMI）一体化区域救治网络的可行性，并评估该网络的实施效果。

方法

基于实时心电图传输技术，我们以厦门心脏中心为核心中心，将120急救系统、具备PCI能力的医院及其他社区卫生单位作为该网络的核心要素，建立了STEMI一体化区域救治网络（IRN-STEMI）。比较厦门心脏中心在IRN-STEMI建立前（n = 165）和建立1年后（n = 343）的再灌注治疗数据，包括接受直接经皮冠状动脉介入治疗（PCI）的患者数量、平均首次医疗接触至球囊扩张（FMC-to-B）时间、平均门到球囊扩张（D-to-B）时间、平均住院时间、平均医疗费用及住院死亡率。

结果

与IRN-STEMI建立前的时代相比，网络内IRN-STEMI建立后直接PCI比例显著提高（84.5%（290/343）对75.5%（185/245））（P = 0.06）。厦门心脏中心收治的STEMI患者从165例显著增加至256例，年平均FMC-to-B时间（（110.3±34.0）分钟对（137.9±58.5）分钟，P < 0.01）和D-to-B时间（（76.5±33.0）分钟对（107.3±38.0）分钟，P < 0.01）以及平均医疗费用显著降低（（51398±22100）元对（56970±24593）元，P < 0.05），而厦门心脏中心在IRN-STEMI建立前后的平均住院时间（（9.0±4.3）天对（9.7±4.8）天，P > 0.05）和住院死亡率（3.1%（8/256）对3.0%（5/165），P > 0.05）保持不变。

结论

在中国建立STEMI患者一体化区域网络系统是可行的。通过合格的心脏中心、急救医疗服务（EMS）以及具备和不具备PCI能力的当地医院之间的协作，IRN-STEMI的建立有效提高了STEMI患者的直接PCI比例，还显著缩短了FMC-to-B和D-to-B时间，降低了平均医疗费用，因此，区域性IRN-STEMI网络可能是改善STEMI患者医疗救治的有效工作系统。