胸痛诊疗远程信息平台对胸痛中心医疗效率的影响与临床决策分析  

Effect of remote medical information platform on efficiency of chest pain diagnosis and treatment and on a clinical decision analysis in chest pain center

作　　者：马懿[1] 石蓓[1] 许官学[1] 赵然尊[1] 王小鹏[1] 曾玲玲[1] 田洪琴[1] Ma Yi;Shi Bei;Xu Guanxue;Zhao Ranzhun;Wang Xiaopeng;Zeng Lingling;Tian Hongqin(Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China)

机构地区：[1]遵义医学院附属医院心血管内科,563000

出　　处：《中华老年医学杂志》2019年第2期141-146,共6页Chinese Journal of Geriatrics

基　　金：贵州省科技计划项目[黔科合LH字(2017)7109号].

摘　　要：目的观察胸痛诊疗远程信息平台(胸痛平台)在胸痛中心医疗效率中的影响并进行临床决策分析。方法入选胸痛平台系统建立前后半年我院胸痛中心救治患者共537例,其中平台建立前组251例、平台建立后组286例,比较两组患者的急性冠状动脉综合征(ACS)构成比情况、急诊溶栓例数、急诊经皮冠脉介入术(PCI)例数,以及平均转诊时间、首次医疗接触到球囊扩张时间(FMC-to-B)、进入医院大门至球囊扩张时间(D-to-B)等指标,并对D-to-B达标与否进行多因素的临床决策分析。结果与胸痛平台建立前92例(36.7%)、15例(6.0%)、(360.7±107.4)min、(583.4±125.1)min、(148.2±41.7)min比较,平台建设后的救治例数249例(87.1%)、溶栓例数64例(22.4%)均显著增加(χ^2=146.56、28.61,P=0.001、0.001);平均转诊时间(176.3±86.1)min、FMC-to-B时间(203.8±65.9)min、D-to-B时间(86.5±30.6)min均显著缩短(t=11.53、8.41、4.49,P=0.008、0.022、0.041),且D-to-B时间达到胸痛中心<90min标准;根据胸痛平台建立后D-to-B达标与否,通过临床决策模型分析结果显示,是否转诊上级医院的平均基尼指数减少量(MDG)最高,其他依次是平均转诊时间与是否急诊溶栓。结论通过临床胸痛数据分析,结合胸痛平台建设,努力缩短平均转诊时间、提高院间转诊效率是本区域胸痛中心建设的重点。ObjectiveTo investigate the effect of remote medical information platform on efficiency of chest pain diagnosis and treatment and on clinical decision analyses in chest pain center. MethodsA total of 537 chest pain patients who met the inclusion and exclusion criteria were consecutively enrolled and divided into two groups.The group without the chest pain platform(before setting up the platform)was 251 cases, and the group with chest pain platform(after setting up the platform)was 286 cases.The constituent ratio of acute coronary syndrome(ACS), the numbers of cases of both emergency thrombolysis and emergency percutaneous coronary intervention(PCI), the mean transfer treatment time, the first time medical contact to balloon catheter technique(FMC-to-B)and the door-to-balloon(D-to-B)time were compared between the two groups.The important multivariate factors affecting the D-to-B time were analyzed. ResultsThe group with versus without chest pain platform showed the statistically significant improvements in the parameters as follows: (1)getting long range treatment(249 cases or 87.1% vs.92 cases or 36.7%, χ^2=146.56, P<0.05), (2)receiving thrombolysis(64 cases or 22.4% vs.15 cases or 6.0%, χ^2=28.61, P<0.05), (3)average transfer treatment time(TTT)(176.3±86.1 min vs.360.7±107.4 min, t=11.53, P<0.05), (4)FMC-to-B(203.8±65.9 min vs.583.4±125.1 min, t=8.41, P<0.05)and (5)D-to-B time(86.5±30.6 min vs.148.2±41.7 min, t=4.49, P<0.05). Especially, patients after setting up the chest pain platform reached the standard of D-to-B time less than 90 min.According to whether reaching the standard of D-to-B time or not, clinical decision-making model analysis showed that the average Gini coefficient achieving the millennium development goal(MDG)was highest in the hospital referral, followed by the average transfer treatment time and emergency thrombolysis. ConclusionsReducing average transfer treatment time, improving the efficiency of hospital referral, and refining the remote terminal information platform for chest pai

关 键 词：胸痛 远程医学 决策支持系统 临床 

分 类 号：R459.7[医药卫生—急诊医学]