胸痛中心对心肌梗死急诊介入时间的影响  

Survey of tele-consultation on Internet for care of myocardial infarction carried out by the chest pain center

作　　者：秦伟毅[1] 钱洪津[1] 唐绍辉[1] 卢勇[1] 彭雄[1] 段天兵[1] 

机构地区：[1]广州军区广州总医院急诊科,广州510010

出　　处：《中华急诊医学杂志》2013年第10期1147-1152,共6页Chinese Journal of Emergency Medicine

基　　金：广东省科技厅粤港关键领域重点突破项目（2011A011304002）;广东省科技计划项目（201lB031800204、128050300021）

摘　　要：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年发病一首次医疗接触（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-FMC2010、2011和2012年组的中位时间分别为112、62、78min，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、421．8min，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、59min，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。Objective To study the efficiency of tele-consuhation on Internet with transmitting real- time 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 groupA, group B and group C were 112, 62 and 78 rains, and the differences among three groups were not statistically signifieant（ 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 Intcrnet of things can effectively shorten the duration of D2B in STEMI patients. However, the reduction o

关 键 词：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 

分 类 号：R542.22[医药卫生—心血管疾病]