中国胸痛中心质控中心对已认证胸痛中心救治流程改进的作用

Effect of quality control center of China chest pain center on chest pain management procedure improvement in certificated chest pain center

目的探讨中国胸痛中心质控中心成立及监测对各胸痛中心救治流程关键指标的促进作用。方法本研究入选了2015年12月前通过认证的所有6个批次的胸痛中心,共53家。摘取2015年的数据作为质控中心成立前的基线水平,2016年的数据作为质控中心成立后的水平,比较质控中心成立前后各胸痛中心救治流程关键指标的变化情况。结果与2015年相比,2016年各胸痛中心院内流程关键指标均有不同程度的改善,包括心电图至确诊时间[(175±519)分钟︰(76±544)分钟,P=0.001]、急性冠状动脉综合征患者确诊至双重抗血小板治疗时间[(163±684)分钟︰(101±466)分钟,P=0.060]、ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的入门至球囊扩张时间[(87±52)分钟︰(80±27)分钟,P=0.003]、PPCI术后心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)Ⅲ级血流比率[(80.3%±32.8%)︰(85.2%±28.2%),P=0.004];然而,院前关键指标除心电图远程传输比率[(31.2%±36.9%)︰(41.2%±39.0%),P=0.000]外,症状至首次医疗接触时间[(697±861)分钟︰(787±1207)分钟,P=0.142]、首次医疗接触至心电图时间[(68±781)分钟︰(61±273)分钟,P=0.839]均未见明显改善。结论目前我国已认证胸痛中心的胸痛救治流程还有待进一步提高,详细而严格的质控有助于提高胸痛中心的救治水平。

Objective To investigate the effect of establishment and monitoring of quality control center of China chest pain center（CPC） on the improvement of key index of chest pain management procedure in certificated CPC. Method All 53 CPCs, which was certificated before December, 2015 in the first 6 batches. The data from 2015 was extracted as the baseline before quality control, while the data from 2016 as the result of quality control. Result Compared with the data in 2015, the key indexs reflexing in-hospital procedure in 2016 improved considerately, including electrocardiogram to diagnosis time [（175±519） min vs.（76±544） min, P =0.001], diagnosis to dual antiplatelet therapy time for patients with acute coronary syndrome [（163±684） min vs.（101±466） min, P = 0.060], door-to-balloon time for primary percutaneous coronary intervention（PPCI） in ST-segment elevation myocardial infarction [（87±52） min vs.（80±27） min, P = 0.003], and TIMI Ⅲ flow post PPCI [（80.3%±32.8%） vs.（85.2%±28.2%）, P = 0.004]. However, pre-hospital key index including symptom to first medical contact time（FMC） [（697±861） min vs.（787±1207） min, P = 0.142] and FMC to electrocardiogram time [（68±781） min vs.（61±273） min, P = 0.839] did not reduce significantly, while electrocardiogram long-distance transmission rate increased from（31.2%±36.9%） to（41.2%±39%）（P = 0.000）. Conclusion The chest pain management procedure in certificated CPC need further improvement, and detailed and strict quality control was useful for acceleration of the process.