非胸痛急性心肌梗死患者冠状动脉 再通时间的院前影响因素分析  

Pre-hospital delay factor of coronary reperfusion therapy for acute myocardial infarction patients presenting with non-chest pains

作　　者：刘晓鹏[1] 冯青俐[1] 郑锐锋[2] 朱平[1] 陈剑锋[3] 

机构地区：[1]郑州大学附属洛阳中心医院急诊科,河南洛阳471009 [2]郑州大学附属洛阳中心医院康复科,河南洛阳471009 [3]郑州大学附属洛阳中心医院心内科,河南洛阳471009

出　　处：《中华危重病急救医学》2016年第7期603-606,共4页Chinese Critical Care Medicine

基　　金：河南省洛阳市科技发展计划(1304104B)Fund program:Scientific Development Program of Luoyang in Henan Province

摘　　要：目的：探讨无胸痛症状的ST段抬高型急性心肌梗死（STEAMI）患者冠状动脉（冠脉）再通时间的院前影响因素。方法采用回顾性观察性研究方法，分析2013年8月至2015年8月郑州大学附属洛阳中心医院收治的进行急诊经皮冠状动脉介入治疗（PCI）的STEAMI患者的临床资料，根据发病时是否有胸痛表现将患者分为胸痛组和非胸痛组。比较两组患者的一般临床特征、主要心脏不良事件（MACE）发生率、入院至冠脉再通时间、就诊至心电图获得时间及获得心电图至入导管室时间。采用logistic多元逐步回归分析冠脉再通的影响因素。结果共259例STEAMI患者入选，其中胸痛组154例，非胸痛组105例。与胸痛组比较，非胸痛组女性较少（26.67%比42.20%，P＜0.05），年龄更大（岁：68.1±8.93比62.34±7.12，P＜0.05），脑卒中、心绞痛、心力衰竭等既往史发生率更高（分别为27.61%比13.63%，31.42%比18.83%，26.67%比11.68%，均P＜0.05），Killip分级≥Ⅲ级的患者比例更高（15.24%比6.49%，P＜0.05），救护车送至医院的比例较低（26.67%比44.81%，P＜0.01），住院时间较长（d：12.50±2.89比9.50±2.67，P＜0.05），MACE发生率较高（19.05%比9.09%，P＜0.05），入院至冠脉再通时间及就诊至心电图获得时间较长（min：159.01±51.21比115.31±36.74，53.06±18.17比30.35±9.93，均P＜0.01）。多元logistic回归分析显示，无胸痛症状〔优势比（OR）＝5.14，95%可信区间（95%CI）＝2.34～10.81，P＜0.001〕、年龄≥65岁（OR＝1.43，95%CI＝0.93～2.99，P＝0.022）、糖尿病（OR＝1.57，95%CI＝0.66～2.15，P＝0.015）及非救护车运送（OR＝1.55，95%CI＝0.73～2.75，P＜0.001）是冠脉再通时间延迟≥2h的危险因素。结论无胸痛症状的STEAMI患者较有胸痛症状者有更高的MACE发生率，心电图获得时间及最初PCI时间延迟；临床医生应尽力减少该类患者的时间延迟，以Objective To explore pre-hospital delay factor of coronary reperfusion therapy for ST-elevation acute myocardial infarction （STEAMI） patients presenting with non-chest pains. Methods A retrospective observation was conducted. The clinical data of STEAMI patients underwent emergency percutaneous coronary intervention （PCI） admitted to Luoyang Central Hospital Affiliated to Zhengzhou University from August 2013 to August 2015 were analyzed. The patients were divided into chest pain group and non-chest pain group according to the presence of chest pain or not. Clinical characteristics were compared between the two groups, and incidence of major adverse cardiac events （MACE）, door-to-balloon time, door-to-electrocardiograms （ECG） time and ECG-to-balloon time were evaluated. Influencing factors of pre-hospital delay was analyzed by logistic multiple stepwise regression. Results A total of 259 patients with STEAMI were enrolled, including 154 patients with chest pain and 105 presented with non-chest pains. Compared with chest pain group, the patients in the non-chest pain group were older （years： 68.12±8.93 vs. 62.34±7.12, P 〈 0.05）, less female （26.67% vs. 42.20%, P〈 0.05）, and had a higher past history of angina, stroke and heart failure （27.61% vs. 13.63%, 31.42% vs. 18.83%, 26.67% vs. 11.68%, respectively, all P 〈 0.05）, and higher percentage of Killip ≥ Ⅲ patients （15.24% vs. 6.49%, P 〈 0.05）, the lower ambulance use （26.67% vs. 44.81%, P 〈 0.01）, longer hospitalization time （days： 12.50±2.89 vs. 9.50±2.67, P 〈 0.05）, higher incidence of MACE （19.05% vs. 9.09%, P 〈 0.05）, longer door-to-balloon time and door-to-ECG time （minutes： 159.01±51.21 vs. 115.31±36.74, 53.06±18.17 vs. 30.35±9.93, both P 〈 0.01）. It was shown by logistic multivariate regression analysis that no-chest pain [odds ratio （OR） = 5.14, 95% confidence interval （95%CI） = 2.34-10.81, P 〈 0.001], age ≥ 65 years old （OR = 1.43, 95%CI = 0.93-2.99, P = 0.022�

关 键 词：ST段抬高型急性心肌梗死 非胸痛 冠脉再通时间 院前延误 影响因素 

分 类 号：R542.22[医药卫生—心血管疾病]