目的 通过胸痛智能化平台的构建及应用,探讨其在急性ST段抬高型心肌梗死患者救治效率及临床预后的影响。方法 由多学科成员组成胸痛智能化平台管理小组,将院前急救系统、医院电子病历系统、检验科信息系统、影像归档和通信系统融为一体,构建胸痛智能化平台并将其应用于急性ST段抬高型心肌梗死患者的救治与护理。选取2021年4月—2023年5月在深圳市某三级甲等医院急诊科就诊的急性ST段抬高型心肌梗死患者172例,以应用胸痛智能化平台前后分为对照组和试验组各86例,比较两组救治时间、效率及预后等指标的差异。结果 应用胸痛智能化平台后,试验组发病至首次医疗接触时间、首次医疗接触至导丝通过时间、进医院大门至导丝通过时间、首次医疗接触至使用双联抗血小板治疗时间、入门至造影时间均显著低于对照组,差异具有统计学意义(均P<0.05)。试验组患者出院时的氨基末端B型脑钠肽前体水平显著低于对照组(P<0.05),但两组出院时左心室射血分数差异无统计学意义(P=0.828)。结论 应用胸痛智能化平台可缩短急性ST段抬高型心肌梗死患者救治各环节的时间,提高救治效率,改善患者预后。
谭薇
,
刘薇
,
汤东三
,
谢小华
,
皮玲丽
,
齐楚怡
,
王亚娟
,
李玉萌
,
成守珍
. 胸痛智能化平台的构建及在ST段抬高型心肌梗死患者中的应用[J]. 中华急危重症护理杂志, 2024
, 5(6)
: 557
-561
.
DOI: 10.3761/j.issn.2096-7446.2024.06.014
Objective To construct and apply an intelligent platform for chest pain and explore the impact on the treatment efficiency and clinical prognosis of patients with acute ST-segment elevation myocardial infarction. Methods A multidisciplinary team was formed to manage the chest pain intelligent platform,integrating the pre-hospital emergency system,hospital electronic medical record system,laboratory information system,image archiving and communication system to construct the Chest Pain Intelligent Platform and apply it to the treatment and care of patients with acute ST-segment elevation myocardial infarction. We selected 172 patients with acute ST-segment elevation myocardial infarction who attended the emergency department of a tertiary hospital in Shenzhen from April 2021 to May 2023,and divided them into 86 cases in the control group and 86 cases in the experimental group before and after the application of the intelligent platform for chest pain,compared the differences in the treatment time,efficiency and prognosis of the two groups. Results After the application of the chest pain intelligent platform,the time from onset to first medical contact,the time from first medical contact to guidewire passage,the time from entering the hospital gate to guidewire passage,the time from first medical contact to the use of duplex antiplatelet therapy,and the time from entrance to imaging in the experimental group were all significantly lower than those in the control group(all P<0.05). Amino-terminal B-type brain natriuretic peptide precursor level at discharge was significantly lower in the experimental group than in the control group(P<0.05),but there was no difference in left ventricular ejection fraction at discharge between the two groups(P=0.828). Conclusion The application of chest pain intelligent platform can shorten the time of various aspects of treatment for acute ST-segment elevation myocardial infarction patients,improve the efficiency of treatment,and improve the prognosis of patients.
[1] 马文君,马涵萍,王运红,等. 《2021年中国心血管病医疗质量报告》概要[J]. 中国循环杂志,2021,36(11):1041-1064.
Ma WJ,Ma HP,Wang YH,et al.2021 medical quality report of cardiovascular diseases in China:an executive summary[J]. Chin Circ J,2021,36(11):1041-1064.
[2] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志,2019,47(10):766-783.
Cardiology Branch of Chinese Medical Association,Editorial Board of Chinese Journal of Cardiology. 2019 Chinese Society of Cardiology(CSC) guidelines for the diagnosis and management of patients with segment ST elevation myocardial infarction[J]. Chin J Cardiol,2019,47(10):766-783.
[3] 沈迎,王伟民,张奇,等. 经皮冠状动脉介入治疗2022年度临床研究进展[J]. 中国介入心脏病学杂志,2023,31(1):25-32.
Shen Y,Wang WM,Zhang Q,et al.Clinical research update on percutaneous coronary intervention in 2022[J]. Chin J Interv Cardiol,2023,31(1):25-32.
[4] 屠袁园,赵菊伟. 急性ST段抬高型心肌梗死患者冠脉介入治疗后近期预后的相关影响因素分析[J]. 中国卫生统计,2019,36(3):392-394.
Tu YY,Zhao JW.Analysis of related factors of short-term prognosis in patients with acute ST-segment elevation myocardial infarction after coronary intervention[J]. Chin J Health Stat,2019,36(3):392-394.
[5] 苏州工业园区东方华夏心血管健康研究院,中国医师协会胸痛专业委员会,霍勇,等. 《胸痛中心质控报告(2022)》概要[J]. 中国介入心脏病学杂志,2023,31(11):820-827.
Dongfang Huaxia Cardiovascular Health Institute of Suzhou Industrial Park,Chest Pain Professional Committee of Chinese Physician Association,Huo Y,et al. Summary of chest pain center quality control report(2022)[J]. Chin J Interv Cardiol,2019,31(11):820-827.
[6] 国家卫生健康委,国家中医药局. 关于开展全面提升医疗质量行动(2023—2025年)的通知[J]. 中华人民共和国国家卫生健康委员会公报,2023(5):8-14.
National Health Commission,National Administration of Traditional Chinese Medicine. Circular on carrying out the action of comprehensively improving the quality of medical care(2023-2025)[J]. Gaz Natl Health Comm People's Repub China,2023(5):8-14.
[7] 向定成. 中国冠心病介入治疗发展现状:ST段抬高心肌梗死救治及胸痛中心建设[J]. 中国医学前沿杂志(电子版),2021,13(3):1-5.
Xiang DC.Development status of intervention therapy for coro-nary heart disease in China:ST segment elevation myocardial infarction and chest pain center[J]. Chin J Front Med Sci Electron Version,2021,13(3):1-5.
[8] 陈玉国,张敏,王文君,等. 护士在胸痛中心建设与发展中的作用[J]. 中华急危重症护理杂志,2020,1(1):7-10.
Chen YG,Zhang M,Wang WJ,et al.The role of nurses in the construction and development of chest pain centers[J]. Chin J Emerg Crit Care Nurs,2020,1(1):7-10.
[9] 胡园芳,唐柚青,林梵,等. 云平台和物联网技术在ST段抬高心肌梗死患者院前急救中的应用效果[J]. 中国数字医学,2019,14(10):104-106,114.
Hu YF,Tang YQ,Lin F,et al.Effect of the application of cloud platform and Internet of Things technology in pre-hospital emergency treatment of patients with myocardial infarction with ST-segment elevation[J]. China Digit Med,2019,14(10):104-106,114.
[10] 林吉怡,陈媛,韩琼,等. 智慧胸痛中心全流程管理与质控系统的设计与应用[J]. 中国护理管理,2022,22(3):461-465.
Lin JY,Chen Y,Han Q,et al.Design and application of the whole-process management and quality control system of the smart chest pain center[J]. Chin Nurs Manag,2022,22(3):461-465.
[11] 周乐琴,徐慧琳,何伟喜. 2型糖尿病合并冠心病患者血清RBP、Lp(a)、NT-proBNP变化及对PCI术后近期主要不良心血管事件的预测[J]. 中国老年学杂志,2023,43(10):2305-2308.
Zhou(L/Y)Q,Xu HL,He WX. Changes of serum RBP,Lp(a) and NT-proBNP in patients with type 2 diabetes mellitus complicated with coronary heart disease and prediction of major adverse cardiovascular events in the near future after PCI[J]. Chin J Gerontol,2023,43(10):2305-2308.
[12] 张志扬,蔡蔚萍,吴志辉,等. 不同射血分数心力衰竭患者临床特征和预后分析[J]. 医学理论与实践,2023,36(18):3065-3068.
Zhang ZY,Cai WP,Wu ZH,et al.Clinical characteristics and prognosis in patients with heart failure and different ejection fraction[J]. J Med Theory Pract,2023,36(18):3065-3068.