基层医院通过微信院前激活导管室对急性ST段抬高型心肌梗死病人再灌注时间的影响

摘要

目的 探讨基层医院通过智能手机微信院前激活导管室对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)病人再灌注时间的影响.方法 通过智能手机微信群,潞河医院与120急救中心及周边20余家非急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)基层医院建立STEMI病人区域协同救治系统.将2015年7月至2016年7月微信群建立后基层医院转诊的STEMI病人分为2组:导管室组(n=48)通过微信群激活、急救服务系统(Emergency Medical System,EMS) 120将病人直接送入导管室.对照组(n=52),通过微信群激活、EMS将病人送至急诊后再送导管室.比较2组病人首次医疗接触至器械(first medical contact-to-device,FMC2D)时间、FMC2D时间指南达标率和门器械(door to device,D2D)时间.结果 2组病人的基线临床资料和冠状动脉造影资料差异均无统计学意义(P均＞ 0.05).与对照组相比,导管室组的FMC2D中位数时间明显缩短(98.0 min vs 151.4 min,P＜0.001),FMC2D时间指南达标率明显提高(60.4％ vs 25.0％,P＜0.001),D2D中位数时间明显缩短(21.7 min vs 54.0 min,P＜0.001).住院期间2组各死亡2例(4.17％ vs 3.85％,P＞0.05).结论 基层医院通过微信激活导管室将STEMI病人直接转运至导管室可明显缩短FMC2D和D2D时间,提高FMC2D达标率.%Objective To evaluate the impact of pre-hospital cardiac catheterization laboratory (CCL) activation by WeChat group in community hospital without percutaneous coronary intervention (PCI) capability for seamless transfer bypassing emergency department on reperfusion time in ST-segment elevation myocardial infarction (STEMI) patients.Methods A regional collaborative network based on Wechat group was developed,consisting of a PCI center,emergency medical service (EMS) and over 20 Non-PCI capacity hospitals.One hundred STEMI patients with pre-hospital 12-lead electrocardiogram transmission and confirmed by teleconsultation via WeChat,initially seen in a community or non-PCI-capable hospital were enrolled in this retrospectively study from July 2015 to July 2016.Two groups were divided:CCL group had 48 patients taken by EMS and transferred directly to CCL,control group had 52 patients who transferred by EMS to emergency department before CCL arrival.FMC2D times,D21D times and mortality rate in hospital between two groups were compared.Results The baseline clinical data and angiographic features among 2 groups were similar (all P ＞ 0.05).Compared to control group,CCL group has shortened FMC2D time (98.0 min vs 151.4 min,P ＜ 0.001),shortened D2D time (21.7 min vs 54.0 min,P ＜ 0.001).More patients in CCL group meet the standard of guideline for FMC2D time (60.4％ vs 25.0％,P ＜ 0.001).There was no difference of the Mortality rate (4. 17% vs 3. 85% , P > 0. 05) in hospital between two groups. Conclusion Direct transfer of STEMI patients to the CCL for primary PCI was associated with shorter FMC2D and D2D time and results in a greater proportion of patients meeting guideline recommendations.