急性心肌梗死患者诊治院前延误的相关因素

Factors associated with pre-hospital delay in patients with acute myocardial infarction

目的:研究急性心肌梗死(acute myocardial infarction,AMI)患者院前延误的现状,并分析相关影响因素。方法:纳入2014年4月至2016年4月南京医科大学附属无锡第二医院因AMI就诊的患者240例,年龄18~89岁。收集并记录患者基本情况(年龄、性别)、临床资料(发病情况、就诊经过、来院方式、既往史等)等信息,通过半封闭式调查患者求医延迟及首次医疗接触选择倾向性的主观原因。结果:在240例患者中,32.92%发生院前延误,7.9%就诊院前时间超过24 h。Logistic回归分析显示非典型症状、归因错误、糖尿病及未呼叫急诊医疗(emergency medical services,EMS)是院前延误发生的危险因素;非典型症状、糖尿病病史是发生归因错误的危险因素。结论:AMI患者对症状分析错误属常见现象,典型症状有助于患者进行正确归因,降低院前延误的风险。EMS是AMI患者最佳转运方式,可缩短患者就诊院前时间。

Objective： To study the status of pre-hospital delay in patients with acute myocardial infarction（AMI）, and to analyze the related factors, focusing on analysis of influencing factors of patients. Methods： A total of 240 patients aged 18–89 years who were admitted to the Affiliated Wuxi No.2 People＇s Hospital of Nanjing Medical University from April 2014 to April 2016 were enrolled in the study. Then we collected and recorded the following information about the patient： the basic situation（age and sex）, clinical data, semi-closed survey patients＇ reasons for delay to seek medical help and reasons for choice of first medical contact. Results： In 240 cases, 32.92% of patients had pre-hospital delay, 12.08% of patients visited hospital 24 h after the onset of symptoms. Logistic regression analysis showed that atypical symptoms, not to attribute to true cause diabetes mellitus and not called emergency medical services（EMS） were risk factors for prehospital delay. Atypical symptoms and a history of diabetes were risk factors for incorrect attribution. Conclusion： In patients with AMI, misinterpretation of symptoms is common, and typical symptoms are tended to correct attribution of symptoms and reduce the risk of pre-hospital delay. EMS is the best way to transport patients with AMI, which can shorten the time before admission.