基于微信平台区域协同救治对急性ST段抬高性心肌梗死介入治疗再灌注时间的影响  

Impact on reperfusion time of patients with ST-segment elevation myocardial infarction admitting to community hospitals without percutaneous coronary intervention capacity by establishing regional collaborative network with Wechat platform

作　　者：徐荣[1] 郭金成[1] 陈文明[1] 柳子静[1] 郝明辉[1] 张利彬[1] 高国旺[1] 

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京101149

出　　处：《中国医刊》2016年第6期46-49,共4页Chinese Journal of Medicine

基　　金：首都临床特色应用研究专项课题(Z131107002213073);北京市通州区卫生发展专项(twkyzx2014-05)

摘　　要：目的探讨利用微信平台区域协同救治对急性ST段抬高性心肌梗死（ST-segment elevation myocardial infarction,STEMI）经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）再灌注时间的影响。方法以有24小时急诊介入条件的本院为中心,联合120急救系统、通州区所有基层医院和非急诊PCI医院,利用智能手机建立基于微信平台的STEMI急诊介入治疗救治网络,将微信平台运行前2个月（2015年5~6月）的患者设为对照组（n=60例）,运行后3个月（2015年7~9月）的患者设为微信组（n=60例）,观察发病至首次医疗接触（onset to first medical contact,O-to-FMC）时间、首次医疗接触至球囊扩张（first medical contact to balloon,FMC-to-B）时间、首次FMC-to-B时间的达标率、导管室至球囊扩张（cathlab door to balloon,C-to-B）时间、住院天数及住院期间的病死率。结果微信组FMC-to-B的中位数时间明显低于对照组（101.50分钟vs 70.00分钟,P〈0.01）;FMC-to-B时间达标率明显高于对照组[81.67%（49/60）vs 41.67%（25/60）,P〈0.01];住院天数[（5.67±3.43）天vs（5.20±1.49）天,P〉0.05]和住院期间死亡率[3.33%（2/60）vs 3.33%（2/60）,P〉0.05]两组间差异无显著性。结论利用微信平台建立区域协调救治网络具有简单、经济、高效的特点,能明显缩短STEMI患者的FMC-to-B时间,提高FMC-to-B时间的达标率。Objective To investigate the impact on reperfusion time of patients with ST-segment elevation myocardial infarction（STEMI）admitting to community hospitals without percutaneous coronary intervention（PCI） capacity（Non-PCI hospital） by establishing regional collaborative network with Wechat platform. Method A regional collaborative network was developed, consisting of a PCI center and over 30 Non-PCI hospitals and connected by a tele-transmitted real time 12-lead electrocardiogram system. This system enables the cardiologists on duty in PCI center to help the physicians in the Non-PCI hospitals to confirm the diagnosis and choose a reperfusion strategy for STEMI patients. All cardiologists in PCI center and physicians in Non-PCI hospitals were trained to follow the flowchart of reperfusion strategies for STEMI patients to shorten the reperfusion time. The mean time from onset of Non-PCI hospital to the first medical contact（O-to-FMC）, the mean time from the first medical contact to balloon（FMC-to-B）, the days of hospitalization and fatality rate in hospital were compared between the 2 months before and the 3 months after establishment of the regional collaborative network for patients with the first medical contact in all network hospitals. Result After establishment of the regional eollaborative network, the mean FMC-to-B time was significantly shortened from 101.50 mins to 70.00 mins（P 0.01）, the rate of FMC-to-B below 120 mins was increased from 41.67%（25/60）to 81.67%（49/60）（P 0.01）. Conclusion The establishment of regional collaborative network with Wechat platform could shorten the perfusion time for STEMI patients presenting to Non-PCI hospitals.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 心肌再灌注 微信平台 

分 类 号：R541.4[医药卫生—心血管疾病]