江西省胸痛中心质控水平调查分析

Investigation and Analysis of Quality Control Levels of Jiangxi Chest Pain Centers

目的调查分析江西省胸痛中心质控水平及实施效果,并对其存在的不足之处提出相应的改善措施。方法收集江西省11个地市共46家(标准版17家、基层版29家)胸痛中心2020年度质控报告,对其中胸痛患者出现症状至首次医疗接触(S2FMC)时间、胸痛患者首次医疗接触至首份心电图(FMC2ECG)时间、胸痛患者心电图远程传输有效份数比例、入门至导丝通过(D2W)时间、入门至溶栓(D2N)时间、再灌注治疗比例等关键质控指标进行分析。结果各地市胸痛中心S2FMC时间均值均未达到质控标准;各地市基层版胸痛中心FMC2ECG时间均值均达到质控标准,而标准版胸痛中心仅抚州、萍乡地区未达标;各地市标准版胸痛中心心电图远程传输有效份数占比为69.24%,基层版胸痛中心为82.95%。各地市标准版胸痛中心D2W时间达标率为81.33%,其中抚州地区达标率相对较低,为66.98%;基层版胸痛中心D2W时间达标率为74.34%,以南昌地区的36.11%为最低。各地市胸痛中心基层版D2N时间达标率为55.91%,其中赣州地区达标率为57.89%,九江地区达标率为53.57%。各地市标准版胸痛中心再灌注治疗比例为83.99%,基层版胸痛中心为86.90%。结论通过对各胸痛中心质控数据的评估分析,发现在基层医疗机构、院前急救、院前-院内信息衔接、急诊医学科、心内科及介入中心等各个环节、部门存在不足,为胸痛中心下一步的工作改进提供了依据,以不断夯实胸痛中心的建设。

Objective To investigate the levels and efficacies of quality control in Jiangxi chest pain centers,and to propose the corresponding improvement measures aiming at the shortcomings.Methods The 2020 quality control reports of 46 chest pain centers(17 in the standard version and 29 in the basic level version)in 11 cities of Jiangxi province were collected.The time from symptom onset to first medical contact(S2FMC),time from first medical contact to first ECG(FMC2ECG),ratio of effective copies of ECG remote transmission,time from entry to guide wire through(D2W),time from entry to thrombolysis(D2N),ratio of reperfusion treatment,and other key quality control indicators were analyzed.Results The mean value of S2FMC in chest pain centers in all cities did not meet the quality control standard.The average value of FMC2ECG in basic chest pain centers in all cities reached the quality control standard,while the standard chest pain centers only failed to reach the standard in Fuzhou and Pingxiang.The qualified rate of ECG remote transmission in standard chest pain centers in various cities was 69.24%,and that of basic chest pain centers was 82.95%.The compliance rate of D2W value in standard chest pain centers in various cities was 81.33%,of which the compliance rate was relatively low in Fuzhou(66.98%).The compliance rate of D2W value in basic chest pain centers was 74.34%,of which the compliance rate was lowest in Nanchang(36.11%).The average compliance rate of the time from entry to thrombolysis in chest pain centers in various cities was 55.91%,of which the compliance rate was 57.98%in Ganzhou,and 53.57%in Jiujiang.The proportion of reperfusion treatment was 83.99%in standard chest pain centers in various cities,and 86.90%in basic chest pain centers.Conclusion The deficiencies in various links and departments,such as primary medical institutions,pre-hospital first aid,pre-hospital-in-hospital information connection,emergency medicine department,cardiology department and intervention center,can be found early through evaluating and analyzing the quality control data of each chest pain center.The analysis of quality control levels can provide a basis for the improvement of the next step of work and consolidate the construction standard of chest pain centers.