影响北京地区急性心肌梗死患者应用急救医疗服务的因素

Factors related to use of emergency medical services in patients with acute myocardial infarction in Beijing area

目的探讨我国北京地区应用急救医疗服务（EMS）救治急性心肌梗死（AMI）的状况以及影响患者选择EMS的因素。方法采用前瞻性、横断面研究方法，入选2005年9月至2006年12月来自北京21家医院的868例ST段抬高的急性心肌梗死（STEMI）患者，将符合AMI的诊断标准，并排除患者由于另外的临床表现而入院后发生的AMI等情况后，最后入选803例。根据是否应用EMS到达医院分为EMS组和自我转运组两组，采用x^2检验、多因素logistic回归分析（Forwald：Conditional method）等统计方法，对比分析两组资料。结果仅有39．5％的患者使用EMS到达指定的医院（EMS组n=317），60．5％的患者自我到达医院（自我转运组n=486）。逐步logistic回归分析表明，年龄较大[95％可信区间（CI）：1．013～1．038，DR=1．026，P=0．000]、夜间发病（95％CI：1．171～2．186，OR=1．600，P=0．003）、症状无法忍受（95％CI：1．300～2．668，OR：1．863．P=0．001）、接受过心脏病发作的知识训练（95％CI：2．597～6．554，OR=4．125，P=0．ooo）以及较高经济收入（95％CI：1．123～1．717，OR：1．389，P=0．002）、有心力衰竭（95％CI：1．401—2．051，OR：5．300，P：0．014）和脑卒中病史（95％CI：1．036～2．811，OR：1，707，P=0．036）等患者非常显著地应用了EMS。EMS组从发病到医院就诊的时间明显缩短（M，110：143min，P=0．000）。结论年龄较大、夜间发病、症状无法忍受、接受过心脏病发作的知识训练以及较高经济收入、有心力衰竭和脑卒中病史等是预测患者应用EMS的独立变量。

Objective To examine the arailability of Emergency Medicine Services （EMS） to patients with acute myocardial infarction （AMI） in Beijing district and investigate factors influencial in patient＇s option of it. Method This prospective, cross-sectional survey was conducted from December 2005 through November 2006. The patient cohotr studied was consisted 868 consecutive patients with acute ST segment elerated myocardial infarction （STEMI） from 21 participating hospitals in Beijing. The presentation of patients were eonsistented with the criteria of AMI, but if AMI onset occurred after hospitalisation with another clinical presentation were excluded from the study. The final sample of 803 participants were divided into two groups based on the option, namely EMS group and self-transportation group. Qualitative data were compared between two groups by using a Chi-square tests and a multiple binary logistic regression （ Forwald： Conditional method ） was used to determine the relationship between various patient-related factors with the probability of whether or not patients tooh EMS. The odds ratios and 95% confidence interval （CI） were calculated directly from the estimated regression coeffiients. Results Only 39.5 % of patients asked for the EMS at the onset of symptoms （EMS group, n = 317）, and the rest patients called other services （self-transport group, n = 486, 60.5% ）. Stepwise logistic regression analysis revealed that the patients in older age （95% CI： 1.013 - 1.038, OR = 1.026, P = 0.000）, patients with onset of symptoms in the night （95% CI： 1. 171 - 2.186, OR = 1.600, P = 0.003）, patients with unbearable symptoms （95% CI： 1.300 - 2.668, OR = 1.863, P = 0.001 ）, patients with good knowledge of a heart attack （95% CI： 2.597-6.554, OR=4.125, P=0.000）, weahhy patients （95% CI： 1.123- 1.717, OR= 1.389, P=0.002） patients with history of heart failure （95% CI： 1.401 -2.051, 0R=5.300, P= 0.014） and patients with history stroke （95% CI： 1.036 - 2.811, OR = 1.707, P = 0.036） well took EMS.The time from the onset of symptoms of patients to the patients＇s arrival to the gates of hospital was significantly shorter in EMS group （median 110 min vs 143 min, P = 0.000）. Conclusions Factors including older, occurrence of symptom onset in night, unbearable symptoms, patients with good knowledge of a heart attack, higher incomer and those having history of heart failure or stroke were indendent predictors for the availability of EMS by patients.