社交网络联系的建立对转运经皮冠状动脉介入治疗患者救治效率的影响

Impact of social network connections on the treatment efficiency of patients transferred for primary percutaneous coronary intervention

目的探讨区域协同救治体系中院间社交网络联系的建立为转运经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者带来的救治获益。方法纳入2017年1月至2018年12月就诊于成都9家PCI医院行转运PCI的STEMI患者267例,根据是否利用社交网络传输首诊信息将其分为资料传输组(151例)和资料未传输组(116例)。比较两组患者的基本临床特征、救治延误时间、院内急性心力衰竭发生率、院内死亡率、随访主要不良心脑血管事件(MACCE)发生率,并做logistic回归分析,分析影响首次医疗接触至球囊扩张(FMC2B)时间达标的因素。结果两组患者基线资料及造影资料比较,差异均无统计学意义(均P>0.05)。资料未传输组患者FMC2B时间[202(145,318)min比152(110,230)min,P<0.001]、首诊医院进门至出门(DIDO)时间[70(33,176)min比45(26,83)min,P=0.001]及进入PCI医院大门至球囊扩张(D2B)时间[84(55,121)min比65(36,88)min,P<0.001]显著大于资料传输组,且资料传输组患者FMC2B时间(29.1%比13.8%,P=0.003)、D2B时间(78.8%比55.2%,P<0.001)、DIDO时间(37.8%比23.3%,P=0.012)的达标率均高于资料未传输组,差异均有统计学意义。logistic多因素分析显示,首诊10 min内完成心电图(OR 2.853,95%CI 1.198~6.794,P<0.001)、资料网络传输(OR 2.433,95%CI 1.241~4.773,P=0.010)与FMC2B达标率上升呈显著正相关。两组患者30 d、90 d MACCE比较,差异均无统计学意义(均P>0.05);但1年MACCE发生率资料未传输组患者(19.3%比8.1%,P=0.049)显著高于资料传输组,差异有统计学意义。结论采取临床资料网络传输的患者的FMC2B时间、DIDO时间和D2B时间更契合胸痛中心救治时间质控标准,且有更好的临床结局。

Objective To explore the benefits of the establishment of inter-hospital social media connections for patients with ST-segment elevation myocardial infarction(STEMI) transferred for primary percutaneous coronary intervention(PCI) in the regional cooperative network. Methods We enrolled 267 patients from 9 hospitals who had been undergone inter-hospital transfer for primary PCI between January 2017 and December 2018. According to whether the first aid information was transmitted through social media, patients were divided into "data transmission group"(n=151) and"data non-transmission group"(n=116) to compare clinical characteristics, treatment delay and the clinical outcome including in-hospital heart failure, death and MACCE during follow-up. Multivariate regression analysis was used to analyses the infl uencing factors of FMC2 B time. Results There were no significant difference of baseline characteristics and angiographic data between the two groups(both P>0.05). The "data transmission group" had significantly shorter FMC2 B time [152(110,230) min vs. 202(145,318) min,P<0.001], DIDO time [45(26,83) min vs. 70(33,176) min,P=0.001] and D2 B time [65(36,88) min vs. 84(55,121) min,P<0.001] than the control group. In-hospital mortality was similar in two groups, whereas the "data transmission group" had a lower incidence of MACCE at one-year follow-up(8.1% vs. 19.3%,P=0.049). In addition, logistic regression showed that data network transmission was positively correlated with the improvement of the compliance rate of FMC2 B time(OR 2.433,95%CI 1.241–4.773,P=0.010). Conclusions The establishment of inter-hospital data transmission is helpful for emergency management system to meet alliance benchmark established by Chest Pain Center and to improve patients’ clinical outcome.