移动远程医疗在ST段抬高型心肌梗死患者分级诊疗中的应用

The application of a mobile-phone based telemedicine of hierarchical medical system in patients with ST segment elevation myocardial infarction

目的探讨移动远程医疗系统对急性ST段抬高型心肌梗死（STEMI）患者再灌注时间节点及临床预后的影响。方法依据STEMI患者首次医疗接触（FMC）时接诊单元是否配备移动远程医疗系统将患者分为试验组与对照组。观察两组患者转运过程中的各时间节点、在院期间心衰发生率和病死率、24 h左室射血分数（LEF）和总住院天数等。结果试验组各时间节点均短于对照组（P〈0.05）；24 h LEF值对照组高于干预组（50.3±5.1）%和（46.8±3.9）%（t＝2.32，P〈0.05），试验组心源性病死率低于对照组，但差异无统计学意义（4%和7%，χ^2＝0.19，P＝0.66）；试验组总住院时间均低于对照组（6.35±3.68）d和（8.64±5.19）d（t＝2.75，P＝0.01）。结论移动远程医疗系统可缩短STEMI患者时间延迟、改善急性期心功能，降低患者病死率和住院天数。

ObjectiveTo explore the effect of a mobile-phone based two-way referral system on the timing of myocardial reperfusion and on a prognosis of patients with ST segment elevation myocardial infarction（STEMI）.MethodsPatients with STEMI were divided into an intervention group whose first admission clinics were equipped with a telemedicine system at the first medical contact（FMC）, and a control group without a telemedicine system at FMC.The rate of heart failure and cardiac death during hospitalization, every time point of transporting process, the value of left ventricular ejection fractions（LVEF）measured at 24 h, and length of hospital stay were collected and compared. ResultsIn comparison of intervention versus control group, the timing of myocardial reperfusion at every time point was shorter（P〈0.05）, the value of LVEF within 24 h was significantly lower[（46.8±3.9）%]vs[（50.3±5.1）%]（t=2.32, P〈0.05）, the cardiac mortality was lower（4% vs 7%）, without statistical significance（χ^2=0.19, P=0.66）, and the length of hospital stay were lower[（6.35±3.68）d]vs[（8.64±5.19）d]without statistical significance（t=2.75, P=0.01）.ConclusionsA mobile-phone based telemedicine can significantly shorten the time delay of myocardial reperfusion in patients with STEMI, improve heart function in acute stage, and reduce the length of hospital stay.