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探讨

目的探讨急性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。方法回顾性分析328例STEMI患者的一般资料,统计其院前延迟时间(PHD)。并从溶栓成功的257例患者中随机抽取71例作为A组,溶栓失败的71例作为B组,分析其PHD常见和高危影响因素。结果⑴328例PHD为(158±46)min,其中1h内40.6%、2h内42.4%、6h内14.3%、6h以上2.7%;⑵常见因素中,A组中风或心绞痛史病情不明显,活动性胃肠道出血,相关慢性疾病,被动就诊,间接转运和转运耽误比率显著低于B组(P<0.05或P<0.01);⑶病情不明显,间接转运和转运耽误是导致PHD延长的高危因素(P<0.05或P<0.01)。结论应加强心脏疾病相关常识的大众教育,同时完善相关的应急调控体系,确保患者能选择所需时间最短的路线,最快到达能对病情做出有效处理的医院。

Objective To explore the time distribution and influencing factor of PHD for patients with STEMI. Methods The general information of 328 cases of patients with STEMI was analyzed,and the PHD was summarized.71 cases of patients that selected from 257 cases of thrombolytics successful patients were as group A, and 71 caSes of thrombolytics failing patients were as group B, the common and risky influencing factor were analyzed. Results （1）The average time of all patients： （158±46） min.time distribution： in lh：40.6%; in 2h：42.4%; in 6h：14.3%; above 6h：2.7%. （2）In common factors, history of apoplexy or angina, unconspicuous disease syndrome, active bleeding of gastrointestinal tract, related chronic disease, passive emergency treatment, indirect transport and transport delay in group A were significantly less than in group B （P〈0.05 or P〈0.01）. （3）Unconspicuous disease syndrome, indirect transport and transport delay were risky factors that made PHD prolong. Conclusion It should strengthen public education about general knowledge of heart disease, and perfect regulatory system of emergency treatment at same time,to make sure the patients can choose route that needs shortest time,and arrive hospital that can provide effective aid as soon as possible.