急性ST段抬高心肌梗死患者院前延迟时间分布及其影响因素

Time distribution and relative factors of prehospital delay in the patients with acute ST- segment elevation myocardial infarction

目的调查急性ST段抬高心肌梗死(STEMI)患者院前延迟时间分布及其影响因素。方法前瞻性调查412例STEMI患者,记录患者延迟(PD)、转运延迟(TD)和院前延迟(PHD)。将PHD分为≤6h和>6h两组,分析社会描述性因素、临床因素和心理因素对PHD的影响。结果412例STEMI患者院前延迟中位数:PD75min,TD50min,PHD170min。单因素分析与PHD有关的变量是:心绞痛史、典型症状、头晕、晕厥、严重疼痛、突然发作、症状进展、直接到指定医院、怀疑心肌梗死、认为是心脏起源疾病、恐惧感、重视症状、等待症状消失、不愿打扰别人。多因素Logistic回归分析表明:直接到指定医院、突然发病、症状进展、重视症状和担心打扰他人是院前延迟的独立相关因素。结论患者延迟和基层医院诊断延误是院前延迟的主要原因。直接到指定医院、突然发病、症状进展、重视症状和担心打扰他人是院前延迟的独立相关因素。

Objective To investigate time distribution and relative factors of prehospital delay （PHD） in the patients with acute ST - segment elevation myocardial infarction （STEMI）. Methods In this prospective, consecutive study, 412 patients with confirmed STEMI admitted to the study hospital （ Luhe hospital and Xuan Wu hospital ） were studied. Patient delay （PD） , transportation delay （ TD ） and PHD were recorded. According to the median PHD of 6 hours, the patients were divided into 2 different groups： ≤6 h group and 〉 6 h group. Effect of sociodemographic factor, clinical factors and psychological factors on PHD was analysed. Results The following median times were recorded： PD 75 minutes, TD 50 minutes, PHD 170 minutes. Factors associated with PHD in a univariate analysis were history of angina, typical symptoms, dizziness, syncope, severe chest pain, sudden onset, progressive symptoms, directly transferred to study hospital and suspect myocardial infarction, attributing symptoms to heart origin, death anxiety, attention to symptoms, waiting and seeing, worried about troubling others. Logistic Regression Analysis showed the following factors were related to PHD ： directly transferred to study hospital, sudden onset, progressive symptoms, attention to symptoms, worried about troubling others. Conclusion Patient delay and diagnostic dilemmas at the community hospital are the main factors responsible for PHD. Directly transferred to study hospital, sudden onset, progressive symptoms, attention to symptoms, worried about troubling others are the independent factors associated with PHD in the patients with STEMI.