转运性心血管介入诊疗手术1644例经验总结

发布时间：2018-05-01 10:00

本文选题：心血管介入 + 转运　；参考：《广西医科大学》2016年硕士论文

【摘要】：背景与目的：广西医科大学第一附属医院包括东院和西院,由于两个院区相隔10多公里,医疗资源、硬件和软件的配置方面相差较大,类似于两个不同级别的医疗中心。既然转运性PCI应用于STEMI取得了很好的治疗效果,本研究尝试运用同样的运作模式,将需要行介入诊疗手术的非急诊心血管病患者从不具备导管室的西院转运到有相当规模、同时具备有导管室和心脏外科手术条件的东院进行介入诊疗手术,探索这种转运性心血管介入诊疗手术的可行性和有效性。方法：通过查阅病历资料和导管室心血管介入诊疗手术登记本,统计自2008年1月1日到2014年12月31日期间,广西医科大学第一附属医院西院心血管内科住院患者借助救护车转运至东院行心血管介入诊疗的人数、诊疗项目和各自占比,观察各项数据变化趋势,总结转运前、转运中和介入手术后的诊治经验和教训。结果：(1)研究期间,共有1644例患者自西院转运到东院实施心血管介入诊疗手术,其中,1057(64.29%)例为男性患者,587(35.71%)例为女性患者,转运患者中有1445例冠心病,203例心律失常,31例结构性心脏病。冠脉介入诊疗手术占88%(包括冠状动脉造影、经皮冠状动脉介入术),心脏电生理诊疗手术占10%(包括心脏电生理检查、射频消融术、埋藏式心脏起搏器植入术),结构性心脏病介入诊疗手术占2%(包括二尖瓣球囊扩张术、先天性心脏病经皮封堵术),(2)2008年至2014年间,冠脉介入诊疗与心脏电生理诊疗的数量均呈逐年上升趋势,其中冠脉介入诊疗的上升趋势更为明显,(3)研究期间,接受转运性心血管介入诊疗手术的患者均未出现与转运相关的严重并发症。结论：转运性心血管介入诊疗手术是转运性PCI模式的扩展和延伸,它能让那些在医疗资源相对匮乏、医疗技术相对落后的医疗中心接受治疗的患者及时享受到更好的医疗服务,对合理利用现有的医疗资源,提高效率,以及对国家将要实施的区域性医疗中心和分级诊疗政策的制定具重要参与价值。
[Abstract]:Background & objective: the first affiliated Hospital of Guangxi Medical University includes the Eastern Hospital and the Western Hospital. Because the two hospitals are separated by more than 10 kilometers, the allocation of medical resources, hardware and software are quite different, which is similar to the two medical centers of different levels. Since transporter PCI has achieved a good therapeutic effect on STEMI, this study attempts to use the same operating mode to transfer non-emergency cardiovascular patients who need interventional surgery from a western hospital that does not have a catheterization room to a large scale. In order to explore the feasibility and effectiveness of interventional surgery, interventional surgery was performed in the eastern hospital with catheterization and cardiac surgery conditions at the same time. Methods: from January 1, 2008 to December 31, 2014, the records of medical records and the register of cardiovascular intervention in catheter room were reviewed. The number of patients in the Department of Cardiovascular Medicine of the West Hospital, the first affiliated Hospital of Guangxi Medical University, and the proportion of patients in the Department of Cardiovascular Interventional diagnosis and treatment of the first affiliated Hospital of Guangxi Medical University transferred to the Eastern Hospital with the aid of ambulances, the items of diagnosis and treatment and their respective proportions were observed. Experience and lessons of diagnosis and treatment after translocation and interventional surgery. Results during the study, a total of 1644 patients were transported from the Western Hospital to the Eastern Hospital for cardiovascular intervention surgery, of which 1057 cases were male, 587% 35.71) were female, and 1445 cases of coronary heart disease were arrhythmia and 31 cases of structural heart disease. Coronary intervention surgery accounted for 88% (including coronary angiography, percutaneous coronary intervention, cardiac electrophysiologic diagnosis and treatment, 10%) (including cardiac electrophysiological examination, radiofrequency ablation, radiofrequency ablation, etc.) Implantable pacemaker implants, interventional procedures for structural heart disease (including mitral balloon dilatation, percutaneous transcatheter closure of congenital heart disease) accounted for 2 percent of the total from 2008 to 2014. The number of coronary intervention diagnosis and cardiac electrophysiological diagnosis and treatment showed an increasing trend year by year, and the increasing trend of coronary intervention diagnosis and treatment was more obvious during the period of study. No serious transportation-related complications were found in patients undergoing transshipment cardiovascular intervention. Conclusion: the transporter cardiovascular intervention is an extension and extension of the transporter PCI model, which can provide better medical services to the patients receiving treatment in the medical centers where the medical resources are relatively scarce and the medical technology is relatively backward. It plays an important role in making rational use of existing medical resources, improving efficiency, and making the regional medical center and classified diagnosis and treatment policy to be implemented by our country.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654

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