急性心肌梗死患者治疗延误影响因素及对策探讨

Influence factors of treatment delay in patients with acute myocardial infarction and countermeasures

目的探讨急性ST段抬高型心肌梗死(STEMI)患者治疗延误影响因素及对策。方法选择2014年3月~2017年6月浙江省杭州建德市第一人民医院收治的STEMI患者304例作为研究对象,记录患者性别、年龄、合并疾病、个人史、文化程度、症状、体格检查、实验室检查、心电图检查等资料、患者至急诊时间、心电图时间、呼叫会诊时间、术前谈话时间、术前准备时间、导管室人员到位时间、手术室准备时间、患者入门-球囊扩张时间(DTB)时间,观察各种因素与DTB时间的相关性。结果 304例患者中238例患者DTB时间≤90 min,占78.29%,66例患者DTB时间>90 min,占21.71%。DTB>90 min组患者心电图-会诊时间、会诊-完成谈话时间较DTB≤90 min组患者明显降低,差异有统计学意义(P<0.05),两组急诊-心电图时间、术前准备时间、导管室人员到位时间、手术室准备时间相比较,差异无统计学意义(P>0.05)。单因素分析显示:民族、年龄、户籍所在地、家属数量、吸烟、饮酒、高血压、高脂血症、糖尿病、梗死部位不是DTB时间的影响因素(P>0.05),性别、首次发病、家庭月收入、患者了解STEMI、家属了解STEMI、费用支付方式、文化程度、既往PCI史、典型STEMI症状、STEMI症状、外院二次转运、症状-进门时间、肌钙蛋白阳性、非工作时间就诊是DTB时间的影响因素(P<0.05)。多因素Logistic分析显示首次发病、非工作时间就诊是影响DTB的独立危险因素(P<0.05),典型临床症状、典型STEMI心电图、肌钙蛋白阳性、学历大专及以上是DTB的保护性因素(P<0.05)。结论心电图-会诊时间、会诊-完成谈话时间延长是导致DTB延误的主要原因,临床可给予优化绿色通道、优化介入流程、优化谈话技巧等方式,从而缩短DTB。

Objective To discuss the influenc factors of treatment delay in patients with acute ST-segment elevation myocardial infarction （STEMI） and countermeasures. Methods From March 2014 to June 2017, in the First Peoples＇ Hospital of Jiande, 304 STEMI patients were selected, the patients＇ sex, age, combined disease, personal history, educational level, symptoms, physical examination, laboratory tests, electrocardiogram and other information, record patients to emergency time, electrocardiogram time, call consultation time, preoperative talk time, preoperative preparation time, catheterization room staff in place, operating room preparation time, patients＇ DTB time, the correlation between factors and DTB time correlation was observed. Results Among the 304 patients, 238 patients had DTB ≤ 90 min, accounting for 78.29%, and 66 patients had DTB 〉 90 min, accounting for 21.71%. Electrocardiogram-consultation time, consultation-completion time of conversation in patients with DTB 〉 90 min were significantly lower than those in patients with DTB ≤ 90 min, the differences were statistically significant （P 〈 0.05）, but emergency-ECG time, preoperative preparation time, catheterization staff in-service time and operating room preparation time were comapared, the differences were not statistically significant （P 〉 0.05）. Univariate analysis showed that ethnicity, age, household location, number of family members, smoking, drinking, hypertension, hyperlipidemia, diabetes and infarction were not the influence factors of DTB time （P 〉 0.05）. Gender, first onset, family monthly income, patients with STEMI, family knowledge of stemi, cost of payment, educational level, history of prior PCI, typical STEMI symptoms, STEMI symptoms, secondary reciprocation, symptoms-non-work-time visits were influence factors of DTB time （P 〈0.05）. Multivariate Logistic analysis showed that first onset and non-working hours were independent risk factors of DTB （P 〈0.05）. Typical clinical symptoms, typical STEMI electrocardiogram, troponin positive, education above junior college were protective factors of DTB （P 〈 0.05）. Conclusion ECG-consultation time, consultation-completed the talk is the main reason for delays caused by DTB, clinic can be given optimize the green channel, optimize the intervention process, optimize conversation skills, and so on, in order to shorten the DTB.