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目的:检验新建立的全国首个复杂、危重先天性心脏病(先心病)患儿救治网络系统在网络远程会诊、综合转诊的安全性和有效性。方法:通过先心病救治网络系统(系统组96例)和传统转诊途径(传统组148例),完成了244例复杂、危重症先心病的地区内、区域性转诊,分析、比较通过两组途径转诊患儿的基本数据、临床资料、院外停留周期、围手术期恢复状况。结果:系统组患儿年龄12(10~19)个月,传统组患儿年龄12(9.3~19)个月,两组比较差异无统计学意义(P=0.321)。系统组复杂先心病的比例高于传统组,呼吸机辅助通气时间和儿科重症监护室(PIUC)停留时间长于传统组患儿(P=0.002和P<0.001),但系统组的住院总天数少于传统组(P=0.023)。住院期间,两组均无死亡。两组总并发症发生率相似(P=0.447)。但系统组患儿院外停留周期明显短于传统组(1.5±0.5)d vs(5.5±2.5)d,P<0.001),系统组的院外停留总花费明显低于传统组[(464.3±97.4)元vs(1 023.6±231.4)元,P<0.001]。结论:与传统就诊途径的患儿相比,经过先心病救治网络系统转诊的患儿存在复杂先心病的比例较高,住院天数和院前停留时间较短,院前发生费用较低。住院并发症的发生率相似。
OBJECTIVE: To test the safety and efficacy of the newly established network for the treatment and diagnosis of congenital heart disease (congenital heart disease) in China by the first remote consultation and comprehensive referral in the country. Methods: 244 cases of complicated and critically ill patients with congenital heart disease (CHD) were referred and analyzed by using the network system (96 cases in the system group) and the traditional referral method (148 cases in the traditional group) The basic data, clinical data, outpatient stay period and perioperative recovery of children with referral route were analyzed. Results: The children of the system group were 12 (10-19) months old and the children of the traditional group were 12 (9.3-19) months old. There was no significant difference between the two groups (P = 0.321). The proportion of complex congenital heart disease in the system group was higher than that in the traditional group. The duration of ventilator-assisted ventilation and pediatric intensive care unit (PIUC) was longer than that in the traditional group (P = 0.002 and P <0.001) In the traditional group (P = 0.023). During the hospital stay, no deaths occurred in both groups. The two groups had similar rates of overall complication (P = 0.447). However, the total out-of-hospital stay spent in the systematic group was significantly shorter than that in the conventional group (1.5 ± 0.5 vs 5.5 ± 2.5 days, P <0.001) Yuan vs (10223.6 ± 231.4) Yuan, P <0.001]. CONCLUSIONS: Compared with children in traditional approaches, children referred to the network system through congenital heart disease have a higher proportion of complicated congenital heart disease, shorter days of hospitalization and stay in hospital, and lower costs of prehospitalization. The incidence of hospital complications was similar.