影响北京市心肌梗死病人应用急救医疗服务的因素  

Factors associated with use of emergency medical service for acute myocardial infarction in Beijing

作　　者：宋莉[1] 颜红兵[1] 杨进刚[2] 孙艺红[3] 刘书山[4] 李超[4] 胡大一[3] 

机构地区：[1]首都医科大学附属北京安贞医院28病区,100029 [2]中国医学院阜外心血管病医院 [3]北京大学人民医院心脏中心 [4]首都医科大学附属北京同仁医院心血管中心

出　　处：《中华医学杂志》2010年第12期834-838,共5页National Medical Journal of China

基　　金：基金项目：首都紧急医学救援（五分钟）科技工程建设研究项目[京科技发（2005）593]

摘　　要：目的调查北京市急性心肌梗死（AMI）病人急救医疗服务（EMS）应用率并探讨其影响因素。方法多中心现况调查。入选2006年1月1日至12月31日期间就诊于北京市19所医院的789例sT段抬高心肌梗死（STEMI）病人。入院1周内，通过与病人进行结构式访谈及查阅病例记录收集资料。根据到达首诊医院的转运方式将病人分为EMS组和自行转运组，对比分析两组资料。结果仅260例（33．0％）通过EMS转运到达首诊医院，其余529例（77．0％）通过自行转运到达。多元Logistic回归分析显示，年龄／〉65岁（OR1．530，95％C11．050～2．230，P=0．027）、大学及以上受教育程度（OR2．032，95％C11．257～3．284，P=0．004）、冠心病史（OR0．474，95％C11．049—2．458，P=0．029）、症状不能耐受（OR0．592，95％C11．090～2．520，P=0．008）、焦虑（OR0．760，95％C11．238—3．695，P=0．006）以及将症状归于心脏病（OR0．402，95％C11．020—2．171，P=0．041）是应用EMS的独立预测因素。而梗死前心绞痛显著较少了EMS应用（OR0．626，95％C10．431～0．907，P=0．013）。结论北京市仅1／3的STEMI病人发病后选择EMS转运。社会人13学、冠心病史、症状特点和认知因素等影响了病人对EMS的应用。Objective To examine the current ambulance transport rates and ascertain factors associated with use of emergency medical service （EMS） in patients with acute myocardial infarction （AMI） in Beijing. Methods Between January 1 and December 31, 2006, a cross-sectional and muhicenter survey was conducted in 19 hospitals in Beijing and included patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review within 1 week after admission. Patients were categorized into the EMS group and the self-transport group according to their modes of transport to the initial hospital. Data were analyzed by descriptive statistics, univariate and multivariate logistic analysis. Results Of the 789 patients with STEMI, only 260 （ 33. 0% ） arrived at the initial hospital by EMS, while the remaining 529 （77. 0% ） relied on self-transport. Multivariate logistic analysis showed that age I〉 65 years （ OR： 1. 530, 95% CI： 1. 050 - 2. 230, P = 0. 027 ）, higher education level （ OR： 2. 032, 95% CI： 1. 257 - 3. 284, P = 0. 004）, history of coronary artery disease （OR： O. 474, 95% CI： 1. 049-2. 458, P = 0. 029）, unbearable symptoms （OR： 0.592, 95%CI：1. 090-2.520, P =0.008）, anxiety （OR： 0.760, 95% CI：1.238 -3.695, P= 0. 006） and attribution of symptoms to cardiac origin （ OR： 0. 402, 95 % CI： 1. 020 - 2. 171, P = 0. 041 ） were independent predictors of EMS use. However, presence of pre-infarction angina significantly decreased the likelihood of using EMS （ OR： O. 626, 95% CI： O. 431 -0. 907, P = 0. 013）. Conclusions Only onethird of patients with STEMI arrived at the hospital by EMS in Beijing. Demographics, history of coronary artery disease, symptoms characteristics and cognitive factors of patients were associated with the EMS use.

关 键 词：心肌梗死 急救医疗服务 北京 

分 类 号：R542.22[医药卫生—心血管疾病]