基层医疗机构区域心电远程会诊网络运行效果分析

Effectiveness of distance electrocardiographic consultation network for regional primary medical institutions

目的探讨区域心电远程会诊网络在基层医疗机构的运行效果。方法综合性三级医院通过因特网与区域内的56家基层医疗机构建立心电远程会诊网络中心，为基层全科医师提供心电图报告实时审核与反馈、疑难心电图会诊及定期心电诊断技术培训等服务。回顾分析该中心2012年9月至2014年8月的心电数据资料，比较2年的心电图上传及会诊数量以及11种常见异常心电图的会诊、误诊、漏诊情况。结果2年间基层医疗机构共上传心电图86593份，其中疑难会诊3976份；第2年的每月心电图检测数量为（3947±376）份，较第1年的（3269±290）份明显增加（P〈0．01）；2年每月心电图会诊量[（167±21）比（165±23）份]比较差异无统计学意义（P〉0．05）。第2年与第1年相比，基层全科医师对房性早搏、室性早搏、心房颤动、室上性心动过速、右束支传导阻滞、左束支传导阻滞、I度房室传导阻滞、Ⅱ度房室传导阻滞与心肌梗死等9种异常心电图的会诊率、误诊率与漏诊率均显著下降，差异均有统计学意义（均P〈0．05）；对心房扑动与Ⅲ度房室传导阻滞等2种异常心电图的会诊率、误诊率与漏诊率也呈下降趋势，但两年间比较差异无统计学意义（均P〉0．05）。结论建立区域心电远程会诊网络中心有助于提高基层全科医师的心电检测意识与对常见异常心电图的诊断水平。

Objective To evaluate the effectiveness of regional electrocardiographic consultation network for primary medical institutions. Methods A distance electrocardiographic （ECG） consultation center was established in Yuyao People＇s Hospital in September 2012, which was connected to 56 regional primary medical through internet. The online consultation was provided by ECG specialists in the center for general practitioners in regional primary health care institutions. Additionally, the ECG training course was also conducted monthly for general practitioners. The 2-year data of ECG consultation were retrospectively reviewed and the effectiveness of the consultation network was evaluated. Results During the past two years, 86 593 electrocardiograms were uploaded by primary medical institutions, in which 3 976 were required for consultation. The monthly number of electrocardiograms sent by general practitioners was increased from 3 269 ±290 in the first year to 3 947 ± 376 in the second year （ P 〈 0. 01 ）. However, the requirements of ECG consultation were not significantly different between two years. Compared to the first year, the rates of consultation requirements, misdiagnosis and missed diagnosis for ECGs of atrial and ventricular premature beats, atrial fibrillation, supraventrieular tachyeardia, left and right bundle branch blocks, Ⅰ and Ⅱ degree atrioventricular blocks and myocardial infarction were significantly decreased （all P 〈 0. 05 ） in the second year; meanwhile there was a tendency towards the reduction for ECGs of atrial flutter and Ⅲ degree atrioventricular block in the second year. Conclusion The regional electrocardiographic consultation network is effective to improve the capability of primary medical institutions in electrocardiographic diagnosis.