急性ST段抬高型心肌梗死患者延迟就医的影响因素分析  

Influencing factors on the delayed visiting doctors in patients with acute ST elevation myocardial infarction

作　　者：刘东霞[1] 高鹏 段亚伟 王燕庆 尹娜娜 韩玉平[1] LIU Dongxia;GAO Peng;DUAN Yawei(Department of Cardiology,Hebei Provincial People’s Hospital,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院心脏中心,石家庄市050051

出　　处：《河北医药》2021年第2期264-266,270,共4页Hebei Medical Journal

摘　　要：目的研究急性ST段抬高型心肌梗死(STEMI)患者延迟就医的影响因素。方法石家庄市区及周边地区STEMI患者285例,采用统一在调查问卷收集资料,根据患者症状出现至首次医疗接触时间(S-to-FMC)分为早期组(≤3 h)和延迟组(>3 h),分析其心肌梗死相关知识的了解情况、发病后第一反应、发病1 h内重视程度、梗死前48 h心绞痛情况、是否应用急救医疗系统等院前因素的差异,分析影响患者S-to-FMC相关危险因素。P<0.05表示有显著性差异;P<0.01表示有非常显著性差异。结果本研究中显示患者S-to-FMC为115.5(58.5,223.0)min,早期组占67.0%,延迟组占33.0%。单因素分析显示:发病48 h前心绞痛、胸痛症状典型、症状进展、家中发病、发病1 h重视程度、怀疑心脏疾患、否知晓心肌梗死临床表现,与S-to-FMC延长有关(P<0.05)。Logistic回归分析显示:48 h前心绞痛、症状进展、发病1 h重视反应、家中发病与患者S-to-FMC有明显相关性(P<0.05)。发病1 h重视反应、症状进展与S-to-FMC呈负相关(P<0.05),老年、48 h前心绞痛、家中发病与S-to-FMC呈正相关(P<0.05)。结论本研究显示发病1 h内重视自身症状及症状进展缩短S-to-FMC时间,而老年、发病48 h前心绞痛、家中发病延长S-to-FMC时间,应要加强高危患者对自身症状的识别教育,强化胸痛症状的正确处理方式,进一步缩短院前延迟时间。Objective To investigate the influencing factors on the delayed visiting doctors in patients with acute ST elevation myocardial infarction(STEMI).Methods A total of 285 with STEMI who were admitted and treated in our hospital from May 2018 to May 2019 were enrolled in the study,whose clinical data were collected by using a unified questionnaire.According to first medical contact time(S-to-FCM),these patients were divided into early group(≤3h)and delay group(>3h).The patients’knowledge about myocardial infarction,the first response after onset,attention degree within 1h after onset,and the severity of angina pectoris at 48h before myocardial infarction and pre-hospital factors were observed and compared between the two gropups.Moreover the influencing factors on S-to-FCM were analyzed by multiple Logistic regression.Results The median S-to-FCM was 115.5(58.5,223.0)min,67%in early group and 33%in delay group.The single factor analysis showed that the angina pectoris at 48h before myocardial infarction,typical chest pain symptoms,aggravation symptom,home onset,attention degree within 1h after onset,suspected heart disease,and patients’knowledge about myocardial infarction were related with S-to-FCM(P<0.05).Logistic regression analysis showed that the angina pectoris at 48h before myocardial infarction,symptom aggravation,home onset,and the attention degree within 1h after onset were closely related with S-to-FCM(P<0.05).Moreover the attention degree within 1h after onset,symptom aggravation were negatively correlated with S-to-FCM(P<0.05),however,the old age,angina pectoris at 48h before myocardial infarction,home onset were positively correlated with S-to-FCM(P<0.05).And the symptom aggravation,home onset,and the attention degree within 1h after onset were closely related with S-to-FCM(P<0.05).Conclusion The research results show that to pay much attention to self-symptoms and symptom aggravation can shorten S-to-FCM,however,the old age and home onset can prolong S-to-FCM.It is necessary to strengthen the edu

关 键 词：院前延迟 急性ST段抬高型心肌梗死 首次医疗接触 

分 类 号：R542.22[医药卫生—心血管疾病]