县域医疗机构胸痛中心建设现状及相关因素分析

The current situation and related factors of chest pain center construction in county medical institutions of China

目的明确我国县域医疗机构胸痛中心建设现状及相关影响因素。方法对全国25个省份部分县域医疗机构开展问卷调研,主要包括医院基本情况、慢性非传染性疾病管理中心建设情况(含胸痛中心)、县域心电网建设情况、区域医疗卫生信息化建设情况等内容。以胸痛中心建设状态进行分组比较,并进一步评估与胸痛中心认证状态相关的因素。结果共纳入25个省/自治区/直辖市的278个地市921个县的1118家医院,其中11.5%(129家)医院已完成胸痛中心认证。被调研医院中,816家(73.0%)具备静脉溶栓能力,587家(52.5%)拥有心脏介入设备,304家(27.2%)可独立开展急诊经皮冠状动脉介入治疗(PCI)。信息化调研显示,被调研医院中765家(68.4%)在急救时可院前获取心电图,223家(19.9%)建成县域心电网。logistic多因素回归分析显示,可独立开展急诊PCI(OR 2.68,95%CI 1.70~4.21,P<0.001)、已开展冠心病高危人群筛查(OR 1.60,95%CI 1.02~2.52,P=0.042)、已开展胸痛患者随访(OR 2.07,95%CI 1.12~3.83,P=0.021),急救时可提前获取院前心电图(OR 2.99,95%CI 1.49~5.98,P=0.002)以及已有县域心电网覆盖(OR 2.57,95%CI 1.69~3.91,P<0.001)的医院相较于相应的对照组,通过胸痛中心认证的比例更高。结论县域医疗机构的胸痛中心认证状态与急诊PCI能力、信息化建设程度、开展目标人群筛查和随访管理工作等因素有关。此结论为县域医院胸痛中心建设与认证的推广实施提供了依据。

Objective To investigate the current situation and related factors of the construction of chest pain centers(CPCs)in county medical institutes of China.Methods Questionnaire was conducted in the county medical institutions from 25 provinces/autonomous regions/municipalities of China.The main contents of the questionnaire included the basic information of hospitals,present situation of chronic disease management centers(including CPCs),construction of county electrocardiogram(ECG)network and regional medical informatization.Related characteristics were compared among groups under different CPCs construction process,and the factors related to the CPCs accreditation status were further evaluated.Results A total of 1118 hospitals were enrolled from 921 counties of 25 provinces/autonomous regions/municipalities in China.Among them,129 hospitals(11.5%)have already passed CPC accreditation.In total,73.0%(n=816)of the hospitals possessed the ability of intravenous thrombolysis.A total of 52.5%(n=587)of the hospitals had cardiac interventional equipment,27.2%(n=304)could perform emergency percutaneous coronary intervention(PCI)independently.About 68.4%(n=765)of the surveyed hospitals were able to obtain the prehospital ECG,and only 19.9%(n=223)of the surveyed hospitals had built the county ECG network.The multivariate logistic regression analysis indicated that the ability to perform emergency PCI(OR 2.68,95%CI 1.70–4.21,P<0.001),conducting screening high risk population of coronary heart disease(OR 1.60,95%CI 1.02–2.52,P=0.042)and follow-up of patients with chest pain(OR 2.07,95%CI 1.12–3.83,P=0.021),the prehospital ECG acquisition(OR 2.99,95%CI 1.49–5.98,P=0.002)and a county ECG network(OR 2.57,95%CI 1.69–3.91,P<0.001)had higher rates in CPC accreditation group than the corresponding control group.Conclusions The CPC accreditation status in county medical institutions is related to the emergency PCI ability,informatization construction degree,target population screening and follow-up management,which provides a basis for the promotion and implementation of CPC construction and accreditation in county hospitals.