农村及社区远程心电监测管理模式的意义

The Significance of Management Mode about Remote ECG Monitoring in Countryside and Community

目的探讨建立农村及社区远程心电监测管理模式的临床意义。方法 2009年8月至2015年7月,我中心共远程监测心电图51327例,检出异常心电图33062例,其中心律失常13758例、异常ST-T改变13265例、心肌梗死126例。分别进行异常心电图、心律失常、异常ST-T改变及心肌梗死阳性率的统计,对105例病程<6h行溶栓术与21例病程>12h未溶栓的急性心肌梗死患者死亡人数统计。结果共监测十二导联同步24h动态心电图3961例、十二导联同步静态常规心电图47366例,其中异常心电图33062例,阳性率64.4%,心律失常13758例,阳性率26.8%,异常ST-T改变13265例,阳性率25.8%,心肌梗死126例,阳性率0.23%。由网点转入我院治疗的病人7613例,抢救网点急危重症病人3600余例,医院专家通过网络对农村及社区卫生室首诊的复杂病症患者给予了4800余人次的远程指导。结论农村及社区远程心电监测的建立,实现了以基层医疗卫生服务网络为基础的医疗服务体系的公共卫生服务功能,建立了分工明确、信息互通、农村及社区首诊、分级医疗和双向转诊的医疗服务体系。实现了心电图诊断标准化即心电图专业技术质量控制。缩短了急性心肌梗死的诊治时间,降低了急性心肌梗死的死亡率。

Objective To investegate t clinical significance of management model about Remote ECG monitoring in Countryside and Community. Methods We made 51327 ECG from August 2009 to July 2015,including33062 abnomal ECG.13758 cases of arrhythmia, 13265 cases of Abnormal ST-T changes, 126 cases of myocardial infarction. Statistics the positive rate of then. Statistics the death toll Of patients with thrombolytic therapy and without thrombolytic therapy. Results We monitored 51327 ECG, including 3961 cases of 12-lead simultaneous Holter and47366 cases of 12-lead static synchronous ECG, 18265 cases of normal ECG, 33062 cases of unnormal ECG, and the positive rate is 64.4%.13758 cases of arrhythmia, whose positive rate is 26.8%.13265 cases of Abnormal ST-T changes, whose positive rate is 25.8%.126 cases of myocardial infarction, whose positive rate is 0.23%.We treated7613 cases of patients who were transferred from terminal substation.We rescued about 3600 critically ill patients who were transferred from terminal substation. Experts given more than 4800 remote guiding-treatment through the network in rural and community clinics about the first diagnosis, and the patients had complex disorders. Conclusions The establishment of remote ECG monitoring in rural and communities, achieves the public health services which is based on the grassroots health service network. It establishes a health care system which has a clear division labor、information exchange、rural and community first diagnosis、classification medical and two-way referral. It achieves the standable of ECG diagnosis. It shorts the treatment duration of AMI. It reduces the mortality rate of AMI.