综合医院胸痛中心微信平台建立对急性ST段抬高型心肌梗死患者救治效果的影响

Influence of Setting up WeChat Platform of Chest Pain Center in General Hospital on Treatment of Patients With STEMI

目的:探讨综合医院胸痛中心微信平台建立对急性ST段抬高型心肌梗死(STEMI)行直接经皮冠状动脉介入治疗(PPCI)患者救治效果的影响。方法:以2016-11-01到2017-06-30由山西医科大学第一医院行PPCI的77例急性STEMI患者为研究对象,建立包括导管室医务人员、心内科医生、急诊科医生、基层协作医院相关人员、太原市120急救中心医务人员等参与的手机微信群,以微信群建立时间(2017-02-28)为节点,分为对照组(微信群建立前)38例和观察组(微信群建立后)39例。比较两组救治时间、住院期间患者临床事件[包括短期院内死亡、再发心肌梗死、靶血管重建、Killip心功能Ⅱ级以上、主要不良心血管事件(MACE)]的差异情况。结果:(1)观察组首次医疗接触至球囊扩张(FMC-B)时间、急诊室停留时间、首份心电图确诊时间等指标均低于对照组,分别是[(116.87±31.41)min vs(146.45±49.93)min,P<0.01]、[(71.50±20.83)min vs(117.87±34.17)min,P<0.01]、[(2.54±0.73)min vs(7.46±2.15)min,P<0.01]。(2)对照组和观察组在发病至首次医疗接触(S-toFMC)时间、院内死亡、院内再发心肌梗死、靶血管重建、Killip心功能2级以上、MACE等方面差异均无统计学意义(P均>0.05)。(3)S-to-FMC时间影响因素分析:(1)相关性分析显示,受教育程度与S-to-FMC呈负相关(r=-0.473,P<0.01)、接受胸痛教育培训与否与S-to-FMC呈正相关(r=0.543,P<0.01)。(2)多元线性回归分析显示,受教育程度与S-to-FMC存在线性关系(P<0.01)、接受胸痛教育培训与否与S-to-FMC存在线性关系(P<0.01)。结论:综合医院胸痛中心建立微信平台能缩短急性STEMI患者PPCI的FMC-B时间;加强胸痛教育培训同样能缩短S-to-FMC时间。

Objectives：To investigate the effect of setting up We Chat platform on treatment of patients with acute ST-Segment Elevation Myocardial Infarction（STEMI） undergoing Primary Percutaneous Coronary Intervention（PPCI） in Chest Pain Center of general hospital.Methods： On Feb. 28, 2017, we set up a We Chat platform and this We Chat group included medical staff of catheter laboratory, cardiologists, emergency doctors, related personnel of cooperative hospitals, medical staff of Taiyuan 120 Emergency Center. Seventy-seven patients with STEMI undergoing PPCI in the First Hospital of Shanxi Medical University from Nov.1 st, 2016 to Jun. 30 th, 2017 were divided into control group（before We Chat platform） and observation group（after We Chat platform）. The differences of several indexes related to STEMI treatment between the two groups were compared. Results：（1） FMC-B（First medical contact to Balloon） time（ [116.87±31.41]min vs [146.45±49.93] min,P 0.01）, emergency room time（[71.50±20.83] min vs [117.87±34.17] min,P〈0.01） and first ECG diagnosis time（[2.54±0.73] minvs [7.46±2.15] min,P 0.01） were significantly shorter in the observation group than in the control group.（2） There was no significant difference between two groups in S-to-FMC（Symptom to First Medical Contact）, in-hospital death, repeat myocardial infarction and target vessel revascularization, Killip ≥2 and MACE.（3） The degree of education was related to S-FMC（r=-0.473, P〈0.01）; patient education for chest pain was associated with S-FMC（r=0.543, P〈0.01）. Multiple linear regression was performed. S-to-FMC had a linear relationship with the degree of education（P〈0.01） and patient education for chest pain（P〈0.01）.Conclusions： The establishment of We Chat platform in Chest Pain Center of general hospital can shorten FMC-B time for STEMI patients undergoing PPCI and thus improve the efficiency of STEMI treatment. In addition, improving the education for chest pain may shorten S-FMC time.