区域诊疗中心STEMI患者院前就诊时间影响因素分析  

Analysis of factors influencing the pre-hospital treatment time of patients with STEMI in regional diagnosis and treatment center

作　　者：曹岩 韩冰[3] 张娜[3] 娄明[3] 朱可[3] 倪慧[3] 杨柳[3] 王涵 陈梓威 王培安 CAO Yan;HAN Bing;ZHANG Na;LOU Ming;ZHU Ke;NI Hui;YANG Liu;WANG Han;CHEN Ziwei;WANG Pei′an(School of Public Health,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Xuzhou Clinical College of Xuzhou Medical University,Xuzhou,Jiangsu 221009;Xuzhou Central Hospital,Xuzhou,Jiangsu 221009;Jinling Clinical College of Nanjing Medical University,Nanjing,Jiangsu 210002)

机构地区：[1]徐州医科大学公共卫生学院,江苏徐州221004 [2]徐州医科大学徐州临床学院,江苏徐州221009 [3]徐州市中心医院,江苏徐州221009 [4]南京医科大学金陵临床医学院,江苏南京210002

出　　处：《徐州医科大学学报》2023年第4期274-279,共6页Journal of Xuzhou Medical University

基　　金：江苏省研究生科研与实践创新计划项目(SJCX21_1141)。

摘　　要：目的回顾性分析影响区域诊疗中心急性ST段抬高型心肌梗死(STEMI)患者院前就诊时间的影响因素。方法选择2019年6月—2020年3月在徐州市中心医院胸痛中心就诊的STEMI患者为研究对象,统计患者的决策时间(患者自发病到决定就诊时间)和求诊时间(自决定就诊至抵达徐州市中心医院急诊室就诊时间),对决策时间>6 h组和≤6 h组患者人口学信息、发病经过、既往病史等数据进行组间比较;对求诊时间>3 h组和≤3 h组患者就诊信息和医疗机构信息等资料进行组间比较。分别进行多因素Logistic回归分析。结果共纳入421例患者,其中决策时间>6 h的患者271例(64.4%),≤6 h的患者150例(35.6%),文化程度、月收入、工作状态、夜间发病、发病地点、是否对疾病知晓、就诊距离以及有无咨询全科医师的差异有统计学意义(P<0.05),夜间发病和就诊距离远是影响患者决策时间的独立相关因素(P<0.05)。求诊时间>3 h的患者261例(62.0%),≤3 h的患者160例(38.0%);来院途径、夜间发病、就诊距离、首诊医疗机构是否为区域诊疗单位成员的差异有统计学意义(P<0.05),经基层医院转诊和自行来院、夜间发病、就诊距离远和首诊医疗机构非区域诊疗单位成员是影响患者求诊时间的独立相关因素(P<0.05)。结论夜间发病和就诊距离远会延长STEMI患者决策时间,经基层医院转诊和自行来院、夜间发病、就诊距离远和首诊医疗机构非区域诊疗单位成员会延长STEMI患者求诊时间。提高患者及家属对STEMI的认识,充分发挥区域诊疗中心协同救治的作用,可提高STEMI患者救治效率,改善预后。Objective To analyze the influencing factors of pre-hospital treatment time for patients with acute ST-segment elevation myocardial infarction(STEMI)in regional diagnosis and treatment center.Methods STEMI patients who were admitted to Chest Pain Center,Xuzhou Central Hospital between June 2019 and March 2020 were selected.Their decision-making time(time from onset to decision to admit)and time to seek treatment(time from decision to admit to arrival at Emergency Room,Xuzhou Central Hospital)were calculated.Their demographic information,the course of disease and the history of disease were compared between the groups with decision-making time>6 h and≤6 h.Their admission information and medical institution were compared between the groups of patients with>3 h and≤3 h to seek treatment.Multivariate Logistic regression analysis was performed.Results A total of 421 patients were included,including 271(64.4%)patients with>6 h decision-making time and 150(35.6%)patients with≤6 h decision-making time.There were statistical differences in education level,monthly income,working status,night onset,place of onset,awareness of disease,distance to hospital and general practitioner(P<0.05).Night onset and distance to hospital were the independent influencing factors of decision-making time(P<0.05).There were 261(62.0%)patients with>3 h to seek treatment and 160 patients(38.0%)with≤3 h to seek treatment.There were statistical differences in the route of admission,night onset,distance to hospital,and whether the first visit medical institution was a member of regional diagnosis and treatment center(P<0.05).Referral from primary hospitals,self-admission,night onset,long distance to seek treatment,and non-member of regional diagnosis and treatment center for first-visit were the independent influencing factor of time to seek treatment(P<0.05).Conclusions Night onset and long distance to seek treatment can extend the decision-making time of STEMI patients.Referral from primary hospitals,self-admission,night onset,long dista

关 键 词：急性ST段抬高型心肌梗死 区域诊疗中心 决策时间 求诊时间 影响因素 

分 类 号：R195.4[医药卫生—卫生统计学]