微信平台在优化急诊直接经皮冠状动脉介入治疗救治流程中的应用Application of WeChat APP in optimizing the rescue process in transferred primary percutaneous coronary intervention
贺行巍,赵虎,丁晨,王洪杰,刘婉君,徐昶,周强,蒋建刚,严江涛,肖智超,郭小梅,汪道文,曾和松
摘要(Abstract):
目的探讨微信平台在急性ST段抬高心肌梗死(STEMI)患者的转运和救治流程中的应用效果。方法建立以华中科技大学同济医学院附属同济医院胸痛中心为核心,"120"院前急救系统、急诊科以及武汉市周边区域不具备直接经皮冠状动脉介入治疗(PPCI)能力的各基层医院参与的微信群。利用微信平台对疑似STEMI患者的病史和心电图等资料进行传输共享。对比分析微信平台应用之前(2014年12月1日至2015年8月31日)和之后(2015年9月1日至2016年5月31日)两组患者首次医疗接触至球囊扩张(FMC-to-B)时间、入门至球囊扩张(D-to-B)时间、住院期间死亡率以及住院天数的差异。结果微信平台应用前行PPCI的急性STEMI患者共计91例,微信平台应用后行PPCI的患者119例。两组患者支架置入、住院期间死亡率、住院时间比较,差异均无统计学意义(均P>0.05);而微信平台应用后患者的FMC-to-B时间[(115.6±34.0)min比(197.1±45.5)min,P<0.001]和D-to-B时间[(80.4±9.3)min比(133.6±36.7)min,P=0.034]时间均较微信平台应用前患者显著减少,差异均有统计学意义。结论微信平台的应用有助于不具备PPCI能力的医院对STEMI患者进行无缝隙转诊,明显缩短了FMC-to-B和D-to-B时间,提高了救治效率。
关键词(KeyWords): 急性ST段抬高心肌梗死;经皮冠状动脉介入治疗;微信平台
基金项目(Foundation):
作者(Author): 贺行巍,赵虎,丁晨,王洪杰,刘婉君,徐昶,周强,蒋建刚,严江涛,肖智超,郭小梅,汪道文,曾和松
参考文献(References):
- [1]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2013,127(4):529-555.
- [2]丁嵩,何奔.急性ST段抬高心肌梗死介入治疗:关注心肌的有效再灌注.中国介入心脏病学杂志,2015,23(10):573-576.
- [3]Antman EM,Hand M,Armstrong PW,et al.2007 Focused Update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction:a report of the American College of Cardiology/American Heart Association task force on practice guidelines:developed in collaboration with the canadian cardiovascular society endorsed by the American Academy of Family Physicians:2007 writing group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction,writing on behalf of the 2004 writing committee.Circulation,2008,117(2):296-329.
- [4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2015,43(5):380-393.
- [5]Nielsen PH,Terkelsen CJ,Nielsen TT,et al.System delay and timing of intervention in acute myocardial infarction(from the Danish Acute Myocardial Infarction-2[DANAMI-2]trial).Am J Cardiol,2011,108(6):776-781.
- [6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38(8):675-690.
- [7]Keeley EC,Boura JA,Grines CL.Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction:a quantitative review of 23 randomised trials.Lancet,2003,361(9351):13-20.
- [8]Rathore SS,Curtis JP,Chen J,et al.Association of door-toballoon time and mortality in patients admitted to hospital with ST elevation myocardial infarction:national cohort study.BMJ,2009,338:b1807.
- [9]Brodie BR,Stone GW,Cox DA,et al.Impact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction:analysis from the CADILLAC trial.Am Heart J,2006,151(6):1231-1238.
- [10]Oluboyede Y,Goodacre S,Wailoo A.Cost effectiveness of chest pain unit care in the NHS.BMC Health Serv Res,2008,8:174.
- [11]王斌,王焱,叶涛,等.区域协同ST段抬高型心肌梗死救治网络建设探讨.中华心血管病杂志,2014,42(8):650-654.