中国不同地域县级医院冠状动脉介入诊疗能力调查与分析

Investigation and Analysis on Diagnosis and Treatment Ability of Coronary Intervention in County-level Hospitals in Different Regions of China

目的调查中国不同地域的县级医院冠脉介入诊疗能力的情况,探讨地域差异和影响因素。方法对全国25个省、自治区、直辖市271个地市930个县的县级医疗机构开展问卷调研。结果共纳入1042家医院,其中东、中和西部分别有380、377和285家。超过一半医院具备冠状动脉造影设备(60.1%),52.4%的医院可独立开展冠脉造影检查,45.9%可独立开展简单病变经皮冠脉介入治疗(PCI),仅24.8%可独立开展复杂病变PCI,38.6%可独立开展急诊PCI。多因素回归显示:与东部地区医院相比,西部地区医院更少具备独立冠脉造影、独立简单PCI和独立复杂PCI能力。同时,医院级别越高、床位数越多,冠脉介入诊疗能力越强。结论目前,我国县级医院冠脉介入诊疗能力仍然偏低,医院级别、规模和地域是重要影响因素。

Objective To investigate the coronary intervention diagnosis and treatment ability of county-level hospitals in different regions in China, and explore the regional differences and influencing factors. Methods A questionnaire survey was conducted among the county-level medical institutions in 271 cities and 930 counties in 25 provinces, autonomous regions and municipalities. Results A total of 1042 hospitals were included, with 380 in the east, 377 in the middle and 285 in the west. More than half of the hospitals had coronary angiography equipment(60.1%), 52.4% could independently perform coronary angiography, 45.9% could independently perform percutaneous coronary intervention(PCI) for simple lesions, only 24.8% could independently perform PCI for complex lesions, and 38.6% could independently perform emergency PCI. Multivariable regression showed that compared with hospitals in eastern region, hospitals in western region had poorer ability of independent coronary angiography, independent simple PCI and independent complex PCI. Meanwhile, the higher of the hospital level and the more number of beds, the stronger of their coronary intervention diagnosis and treatment ability. Conclusion The coronary intervention ability of county-level hospitals in China was still poor at present. In addition to hospital level and scale,region was also an important factor influencing their ability.