急性心肌梗死介入治疗院内延迟的影响因素

Factors of hospital delay of acute myocardial infarction with percutaneous coronary intervention

目的探讨急性心肌梗死患者介入治疗院内延迟的影响因素。方法回顾性分析2015年1月~2017年8月在北京天坛医院经急诊入院行经皮冠状动脉介入(PCI)治疗的324例急性ST段抬高型心肌梗死(STEMI)患者的临床资料。通过单因素分析比较A组[球囊扩张的时间(DTB)≤90 min,198例]和B组(DTB>90min,126例)的差异,采用Logistic多因素回归探讨院内延迟相关影响因素。结果导致院内延迟时间延长的独立因素为受教育程度低(OR=1.761,95%CI:1.071~2.894,P<0.05)、自行来院(OR=1.765,95%CI:1.087~2.867,P<0.05)、工作日就诊(OR=1.936,95%CI:1.113~3.369,P<0.05)和消化系统疾病史(OR=1.917,95%CI:1.085~3.387,P<0.05)。导致院内延误时间缩短的独立因素为首诊明确(OR=0.339,95%CI:0.207~0.556,P<0.01)和院前延误时间≤120min(OR=0.578,95%CI:0.353~0.947,P<0.05)。结论建议通过多样化的健康宣教手段提高公众知晓率和重视程度;完善急救系统网络,加强院外、院内急救的协同作用,引导公众使用急救车就诊,缩短院前延迟时间;加强医护人员培训,提高分诊、确诊能力;优化医院绿色通道流程,促进科室间有效衔接,提高导管室利用效率。

Objective To investigate the factors of hospital delay of acute myocardial infarction with percutaneous coronary intervention. Methods Restropective analysis was applied to 324 STEMI cases with PCI from emergency in Beijing Tiantan Hospital from January 2015 to August 2017. Univariate analysis was used to compare group A（DTB ≤90 min, 198 cases） and group B（DTB90 min, 126 cases）. Logistic multivariate analysis was adopted to explore related factors. Results Factors of hospital delay were as follows： low level of education（OR=1.761, 95%CI： 1.071-2.894, P0.05）, mode of transport to the hospital without EMS（OR=1.765, 95%CI： 1.087-2.867, P〈0.05）, PCI on work-day（OR= 1.936, 95%CI： 1.113-3.369, P〈0.05） and history of digestive diseases（OR = 1.917, 95% CI： 1.085-3.387, P〈0.05）. There were some factors that could shorten hospital delay such as initial diagnosis with STEMI（OR=0.339,95%CI： 0.207-0.556, P〈0.01） and pre-hospital delay within 120 min（OR=0.578, 95%CI： 0.353-0.947, P〈0.05）.Conclusion It should offer multiform health education to people in order to increase awareness rate and degree of recogniton. Through improving emergency system, enhancing collaboration pre-hospital and in-hospital and promoting more people to use EMS, pre-hospital delay can be shorten. More cultivation on doctors and nurses should be organized to improve ability of triage and prognosis. Optimization of emergency green channel of PCI can promote department cooperation and increase efficiency of DSA to reduce hospital delay.