北京市急性心肌梗死患者决定就医延迟的影响因素  

Factors leading to delay in decision to seek treatment in patients with acute myocardial infarction in Beijing

作　　者：宋莉[1] 胡大一[2] 杨进刚[1] 孙艺红[2] 刘书山[1] 李超[1] 冯齐[1] 武东[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,100730 [2]北京大学人民医院心脏中心

出　　处：《中华内科杂志》2008年第4期284-287,共4页Chinese Journal of Internal Medicine

基　　金：首都紧急医学救援（5分钟）科技工程建设研究项目组子课题之一[京科技发（2005）593]

摘　　要：目的调查北京市急性心肌梗死（AMI）患者决定就医延迟程度及影响因素。方法入选2005年11月至2006年12月底就诊于北京市19所医院并于发病后24h内到院的799例ST段抬高AMI（STEMI）患者。通过与患者进行结构式访谈及查阅病历收集资料。以决定就医延迟30min为切点，分为早决定组及晚决定组，对比分析两组资料。结果中位决定就医延迟为60min。多因素回归分析显示：心肌梗死病史、无晕厥发生、症状呈间断性、症状能够耐受及未将症状归于心脏病是决定就医延迟〉30min的独立预测因素。早决定组患者具有更高的早期再灌注治疗率及更短的发病至再灌注治疗延迟。结论北京市AMI患者决定就医时间明显延迟，既往有心肌梗死病史、症状特点及认知因素影响决定就医延迟程度。Objective To investigate the factors associated with delay in decision to seek treatment in patients with acute myocardial infarction （AMI） in Beijing. Methods This prospective, cross-sectional, multicenter survey was conducted from November 1, 2005 and December 31 ,2006. The participants consisted of 799 patients with STEMI admitted within 24 h of symptom onset to 19 hospitals in Beijing. Data were collected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off. Results The median （25%, 75% ） decision delay in STEMI patients was 60 （20, 180） min. Factors associated with late decision in an univariate analysis were age 365 years, retirement or unemployment, history of myocardial infarction, symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends, coworkers or even strangers, unbearable symptoms, dyspnea, sweating, syncope and attribution of symptoms to cardiac origin were related to early decision. Multivariate logistic analysis showed that history of myocardial infarction, absence of syncope, intermittent symptoms, bearable symptoms and attribution of symptoms to noncardiac origin were independent predictors of decision delay 〉 30 min. Patients in the early decision group had more chances to receive acute repeffusion therapies （ P = 0. 001 ） and shorter time intervals from symptom onset to repeffusion therapies （ P 〈 0. 001 ）. Conclusions To a great extent patients with AMI in Beijing delayed in decision to seek treatment. History of myocardial infarction, symptom characteristics and symptom attribution were associated with decision delay.

关 键 词：心肌梗死 就医 延迟 

分 类 号：R686[医药卫生—骨科学]