急性ST段抬高心肌梗死患者应用急救医疗服务的影响因素

Factors Related to Use of Emergency Medical Services in Patients with Acute ST Segment Elevation Myocardial Infarction

目的探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者到达医院时交通工具的选择类型及影响患者选择急救医疗服务(emergency medical service,EMS)的因素。方法我院住院并确诊的412例STEMI患者,根据是否应用EMS到医院分为两组:EMS组和自我转运组。对比分析两组患者应用急救医疗服务的情况。结果有26.90%的患者应用EMS到医院,单因素分析表明:CAD住院史、恶心、呕吐、头晕、晕厥、症状突然发作、症状进展、发病初期等症状消失、不愿打扰别人、院前就诊次数、认为是心脏起源疾病、恐惧感、重视症状是有意义的变量。多因素Logistic回归分析表明STEMI患者选择EMS的独立变量是院前就诊(0.49,0.33～0.73),恶心(2.57,1.58～4.19),晕厥(5.49,2.05～14.70),症状进展(1.98,1.19～3.29),等待症状消失(0.55,0.34～0.89),认为是心脏起源疾病(2.37,1.44～3.91)。结论1/4的STEMI患者应用EMS到达医院,只有当患者感觉病重时才想到EMS,应当宣传EMS不仅仅是运输工具,同时也是及早诊断和治疗的手段。

Objective To explore the choice of transportation mode to hospital in patients experiencing acute ST elevation myocardial infarction （STEMI） and ascertain the factors that may influence the use of Emergency Medical Service （EMS） in patients with acute STEMI. Methods 412 consective patients confirmed STEMI from Febury 2006 to January 2009 were divided into two groups based on the use of EMS ： EMS group and self - transportation group. A questionnaire developed to assess demographic characteristics, Clinical factors and psychological factors. Paients were interviewed within 72 hours of admission to 2 hospitals. Results EMS was used in 26. 90% of patients with STEMI, actors associated with EMS in a univariate analysis were history of coronary artery disease hospitalization, nausea, vomiting, dizziness, collapse, sudden onset, progressive symptoms,＂ waited and see＂ ,＂ worried about to bother others＂, times of contacting physician before arrived at study hospital, thinking it was a cardiac origin disease. In a multivariate analysis, contact physician （0. 49, 0. 33 - 0. 73 ）, nausea （2. 57, 1.58 -4. 19） , collapse （5.49, 2. 05 - 14.70）, progressive symptoms （ 1.98, 1.19 - 3.29） ,＂ waited and see＂ （0. 55, 0. 34 - 0. 89） and contributed symptoms to cardiac disease （ 2. 37, 1.44 - 3.91 ）. Conclusion Only one fourth of patients with STEMI were transported to the hospital by EMS, they view the EMS as an option for transportation to hospital only if they feel really sick. For that reason, it needs to he made well known to the public that EMS are not only a mode of transport, but also provide diagnostics and treatment.