远程心电图会诊触发快速反应机制对偏远山区急性冠状动脉综合征患者预后的影响
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摘要
目的探讨远程心电图会诊触发快速反应机制对重庆市武陵山偏远地区急性冠状动脉综合征(ACS)患者院前救治和介入术后短期预后的影响。方法采用整群抽样的方法收集黔江中心医院心内科和胸痛中心收治的全球急性冠状动脉事件注册(GRACE)评分大于或等于140分的高危ACS患者93例进行回顾性分析和介入术后随访,并以同期城区患者为对照,比较远程心电图触发的快速反应机制对偏远山区ACS患者介入术后6个月的短期预后和2年累计生存率的差异。结果纳入研究城区和偏远山区高危ACS两组患者人口学数据和疾病基线指标差异无统计学意义(P>0.05);入院方式方面,城区组患者主要乘其他交通工具或自行入院(92.0%),偏远山区组患者主要经医联体医院急救车转送(86.0%)入院;偏远山区组患者进门-球囊扩张时间(67.3±24.7)min,显著低于城区组患者(95.7±46.5)min(P<0.05);偏远山区组患者2年生存率(79.1%)略低于城区组(88.0%),但差异无统计学意义(P=0.242,χ~2=1.376)。结论远程心电图会诊触发快速反应机制增加患者搭乘医联体基层医院救护车的转运率,减少患者进门-球囊扩张时间,有助于改善偏远山区ACS患者的短期预后和生存率。
引文
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[9]郑若龙,陈新军,李伟章,等.利用手机微信群优化基层医院急性心肌梗死急救流程及对患者预后的影响[J].江苏医药,2016,42(14):1604-1606.
[10]罗素新,袁霄,夏勇.从胸痛中心建设看非PCI医院在构建ACS区域协同救治体系中的作用[J].西部医学,2017,29(3):297-300.
[11]杨利娇,王虹,韩婷婷,等.急性冠状动脉综合征患者的临床特征及预后因素分析[J].重庆医学,2018,47(10):1357-1362.
[12]张韶辉,刘立新,魏广和,等.GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估[J].中国循环杂志,2015,16(8):728-732.
[13]陈国钦,李健豪,张稳柱,等.区域性协同胸痛中心对急性ST段抬高型心肌梗死患者的救治时间及短期预后的影响[J].中国介入心脏病学杂志,2017,25(10):579-583.
[2]CHUA S K,CHENG J J,SHYU K G,et al.Improvement in door-to-balloon(D2B)time in acute ST-elevation myocardial infarction through the D2Balliance[J].Circ J,2013,77(2):383-389.
[3]GIBSON C M,PRIDE Y B,FREDERICK P D,et al.Trends in reperfusion strategies,door-to-needle and door-to-balloon times,and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990to2006[J].Am Heart J,2008,156(6):1035-1044.
[4]CHAUHAN V,NEGI P C,RAINA S,et al.Smartphonebased tele-electrocardiography support for primary care physicians reduces the pain-to-treatment time in acute coronary syndrome[J].J Telemed Telecare,2018,24(8):540-546.
[5]JIA E Z,XU Z X,CAI H Z,et al.Time distribution of the onset of chest pain in subjects with acute ST-elevation myocardial infarction:an eight-year,single-center study in China[J].PLoS One,2012,7(3):e32478.
[6]FUJII T,SUZUKI T,TORII S,et al.Diagnostic accuracy of Global Registry of Acute Coronary Events(GRACE)risk score in ST-elevation myocardial infarction for inhospital and 360-day mortality in Japanese patients[J].Circ J,2014,78(12):2950-2954.
[7]MADDER R D,HUSAINI M,DAVIS A T,et al.Large lipidrich coronary plaques detected by near-infrared spectroscopy at non-stented sites in the target artery identify patients likely to experience future major adverse cardiovascular events[J].Eur Heart J Cardiovasc Imaging,2016,17(4):393-399.
[8]朱炜,屠海霞,林仁支,等.基层卫生适宜技术推广平台在心血管病防治中的实践研究[J].心脑血管病防治,2015,15(1):1-3.
[9]郑若龙,陈新军,李伟章,等.利用手机微信群优化基层医院急性心肌梗死急救流程及对患者预后的影响[J].江苏医药,2016,42(14):1604-1606.
[10]罗素新,袁霄,夏勇.从胸痛中心建设看非PCI医院在构建ACS区域协同救治体系中的作用[J].西部医学,2017,29(3):297-300.
[11]杨利娇,王虹,韩婷婷,等.急性冠状动脉综合征患者的临床特征及预后因素分析[J].重庆医学,2018,47(10):1357-1362.
[12]张韶辉,刘立新,魏广和,等.GRACE评分和SYNTAX评分对非ST段抬高急性冠状动脉综合征患者的远期预后评估[J].中国循环杂志,2015,16(8):728-732.
[13]陈国钦,李健豪,张稳柱,等.区域性协同胸痛中心对急性ST段抬高型心肌梗死患者的救治时间及短期预后的影响[J].中国介入心脏病学杂志,2017,25(10):579-583.