先天性心脏病救治网络系统平台--新型的综合转诊系统的应用

Network for Rescuing the Children With Critical Congenital Heart Disease——Application of a Novel Comprehensive Medical Transfer System

目的：检验新建立的全国首个复杂、危重先天性心脏病（先心病）患儿救治网络系统在网络远程会诊、综合转诊的安全性和有效性。方法：通过先心病救治网络系统（系统组96例）和传统转诊途径（传统组148例），完成了244例复杂、危重症先心病的地区内、区域性转诊，分析、比较通过两组途径转诊患儿的基本数据、临床资料、院外停留周期、围手术期恢复状况。结果：系统组患儿年龄12（10～19）个月，传统组患儿年龄12（9．3～19）个月，两组比较差异无统计学意义（P=O．321）。系统组复杂先心病的比例高于传统组，呼吸机辅助通气时间和儿科重症监护室（PIUC）停留时间长于传统组患儿（P：0．002和P〈O．001），但系统组的住院总天数少于传统组（P=O．023）。住院期间，两组均无死亡。两组总并发症发生率相似（P=O．447）。但系统组患儿院外停留周期明显短于传统组（1．5±0．5）dVS（5．5±2．5）d，P〈O．001），系统组的院外停留总花费明显低于传统组[（464．3±97．4）元VS（1023．6±231．4）元，P〈O．001]。结论：与传统就诊途径的患儿相比，经过先心病救治网络系统转诊的患儿存在复杂先心病的比例较高，住院天数和院前停留时间较短，院前发生费用较低。住院并发症的发生率相似。

Objective： To evaluate the efficacy and safety for remote consulting and rescuing the children with critical congenital heart disease （CHD） by the first network transfer system （NTS） in China. Methods： We performed regional transferring in 244 children with complicated and critical CHD by both NTS and traditional system （TS）. NTS group, n=96 and TS group, n=148. We documented and compared the patients＇ basic information, clinical condition, out-hospital time and peri-operative outcomes between 2 groups. Results： The median age in NTS group and TS group were 12 （10-19） months and 12 （9.3-19） months, P=0.321. NTGgroup had more complicated CHD patients, the ventilation time and PICU stay were longer than TS group, P=0.002 and P〈0.001, the total in-hospital stay was shorter than TS group, P=0.023. There was no in-hospital death in either group and the total complication incidence was similar between 2 groups P=0.447. NTS group had less pre-hospital waiting time than TS group, （1.5 ± 0.5） vs. （5.5 ± 2.5） days, P〈O.001 and the cost was lower, RMB （464.3 ± 97.4） vs. （1023.6 ±231.4）, P〈0.001. Conclusion： Compared with TS, the NTS contained more complicated CHD patients, had shorter in-hospital stay, less pre- hospital waiting and lower cost. The total complication was similar between 2 groups.