中国ST段抬高型心肌梗死院前溶栓现状和影响因素的调查研究  

Current status and analysis of influencing factors of prehospital thrombolysis for ST segment elevation myocardial infarction in China

作　　者：汪浩[1] 唐雯奕 马渝[1] 田思佳 贾建平 张文中 张进军[3] 陈辉[3] 肖骏[1] Wang Hao;Tang Wenyi;Ma Yu;Tian Sijia;Jia Jianping;Zhang Wenzhong;Zhang Jinjun;Chen Hui;Xiao Jun(Department of Cardiovascular Medicine,Chongqing Emergency Medical Center/The Fourth People’s Hospital of Chongqing,Chongqing 400014,China;Department of Clinical Data Research,Chongqing Emergency Medical Center/The Fourth People’s Hospital of Chongqing,Chongqing 400014,China;Beijing Emergency Medical Center,Beijing 100031,China;Beijing Health Service Management and Guidance Center,Beijing 100031,China)

机构地区：[1]重庆市急救医疗中心/重庆市第四人民医院心血管内科,重庆400014 [2]重庆市急救医疗中心/重庆市第四人民医院临床数据研究中心,重庆400014 [3]北京急救中心,北京100031 [4]北京市医疗卫生服务管理指导中心,北京101160

出　　处：《中华急诊医学杂志》2024年第11期1529-1535,共7页Chinese Journal of Emergency Medicine

基　　金：北京市高层次公共卫生技术人才培养专项(2022-1-001);2023年重庆市公共卫生重点专科(学科)建设项目(渝卫办发﹝2023﹞81号);重庆市中青年医学高端人才工作室-急性胸痛一体化救治工作室(渝卫人〔2023〕10号)。

摘　　要：目的调研我国ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)院前溶栓救治的现状和影响因素,分析影响院前实施溶栓的主要因素,以优化STEMI院前溶栓策略。方法采用多中心横断面调查研究,以方便抽样的方法从中国六大地理分区中抽取共计21个城市,通过匿名在线电子问卷的方法调查各地院前急救医师及基层医师对STEMI患者实施院前溶栓治疗的现状和影响因素。使用卡方检验分析组间计数资料的差异,使用多因素Logistic回归分析影响STEMI院前溶栓的影响因素。结果共有5163名院前急救医师和基层乡镇卫生院/社区卫生服务中心或村卫生室的医师参与了本次调查。其中3208人(62.13%)从未进行过溶栓,1955人(37.87%)曾进行过溶栓。多因素Logistic回归分析结果显示,工作年限为5~10年(OR=1.41,95%CI:1.18~1.69,P<0.01)、工作年限11~20年(OR=1.25,95%CI:1.03~1.52,P=0.02)、工作单位为村卫生室(OR=1.30,95%CI:1.05~1.61,P=0.02)、工作于院前急救医疗机构/院前急救部门(OR=3.19,95%CI:2.80~3.64,P<0.01)、所在单位具备远程心电传输功能(OR=1.72,95%CI:1.50~1.96,P<0.01)、所在单位具备心电图AI辅助诊断功能(OR=1.31,95%CI:1.15~1.49,P<0.01)、认为溶栓效果显著,应广泛应用(OR=2.55,95%CI:2.09~3.12,P<0.01)、认为溶栓有一定效果,但需谨慎应用(OR=2.11,95%CI:1.73~2.59,P<0.001)的医师面对STEMI患者更易做出实施院前溶栓的决策。院前急救/基层医师认为要改变目前STEMI院前溶栓的现状,排在前4位的措施依次是提高基层医生救治能力(92.22%)、加强上级医院指导(共84.99%)、加强信息化技术支持(83.37%)、加强科普宣传(74.75%)。结论我国STEMI院前溶栓的实施率仍有待提高,优化STEMI院前溶栓策略、加强基础医疗资源配置和信息化技术支持,完善转诊机制等或将有利于STEMI院前溶栓的实施。Objective To investigate the current situation and influence factors of prehospital thrombolysis treatment for ST segment elevation myocardial infarction(STEMI)in China,to analyze the main factors affecting prehospital thrombolysis implementation,and optimize the pre-hospital thrombolysis strategy for STEMI to reduce mortality.Methods A multicenter cross-sectional survey was conducted.21 cities from six major geographical regions in China were selected by using convenient sampling method.An anonymous online electronic questionnaire was used to investigate the current situation and influence factors of prehospital emergency physicians and grassroots physicians implementing prehospital thrombolysis treatment for STEMI patients.Chi-square test was used to analyze the differences in count data between groups,and multivariate logistic regression was used to analyze the factors affecting prehospital thrombolysis in STEMI.Results A total of 5163 prehospital emergency physicians and physicians from grassroots township health centers/community health service centers or village clinics participated in this survey.Among them,3208(62.13%)have never implemtent thrombolysis,and 1955(37.87%)have did it before.The results of the multivariate logistic regression analysis indicated that physicians with 5-10 years of experience(OR=1.41,95%CI:1.18-1.69,P<0.01),11-20 years of experience(OR=1.25,95%CI:1.03-1.52,P=0.02),those working in village clinics(OR=1.30,95%CI:1.05-1.61,P=0.02),those in pre-hospital emergency medical institutions/departments(OR=3.19,95%CI:2.80-3.64,P<0.01),those whose units are equipped with remote ECG transmission capabilities(OR=1.72,95%CI:1.50-1.96,P<0.01),or ECG AI-assisted diagnostic tools(OR=1.31,95%CI:1.15-1.49,P<0.01),and those who believe that thrombolysis is highly effective and should be widely adopted(OR=2.55,95%CI:2.09-3.12,P<0.01)or consider it somewhat effective but warranting caution(OR=2.11,95%CI:1.73-2.59,P<0.001),were more likely to make pre-hospital thrombolysis decisions for STEMI patients.To

关 键 词：ST段抬高型心肌梗死 院前溶栓 现状 影响因素 

分 类 号：R542.22[医药卫生—心血管疾病]