辽西地区农村和城镇急性心肌梗死患者就诊现状对比分析

Treatment status of patients with acute myocardial infarction in rural and urban areas of western Liaoning Province

目的比较辽西地区433例农村和城镇急性心肌梗死(AMI)患者的就诊方式以及发病至到达医院的时间差,分析辽西地区AMI患者的就诊现状。方法回顾性分析2014年1月～2015年1月来自阜新市中心医院和北票市中心医院心内科收治的AMI患者433例,其中男性261例,女性172例,平均年龄66.26±12.51岁。将记录的到达医院时间与此次发病时间的时间差作为院前延误时间(PDT)。统计农村和城镇PDT分布情况、到达医院的方式以及治疗情况。结果城镇和农村AMI患者就诊方式中,自行就诊(379例)多于呼叫"120"急救系统(54例)。城镇和农村ST段抬高型心肌梗死(STEMI)患者溶栓、经皮冠状动脉介入治疗PCI、药物保守治疗不同治疗方式比较差异无统计学意义(P>0.05)。农村组PDT>720 min所占比例最高。城镇组PDT<30 min所占比例最高。在STMEI中,农村组与城镇组比较PDT≤720 min和PDT>720 min差异无统计学意义。在非ST段抬高型心肌梗死(NSTMEI)中,农村组PDT≤720 min所占比例低于城镇组,差异有统计学意义。结论在辽西农村地区,AMI患者普遍存在就诊延迟现象。应在广大农村人群中积极宣传心血管病等健康教育知识,强化AMI急救知识,建立AMI绿色通道以缩短PDT时间,减少就诊延迟现象,为患者赢得再灌注治疗的黄金时间。

Objective To compare the ways of treatment and time difference from disease onset time to hospital arrival time in433patients with acute myocardial infarction(AMI)in rural and urban areas of western Liaoning Province,and analyze their treatment status.Methods AMI patients(n=433,male261,female172and average age=66.26±12.51)were chosen from the Central Hospital of Fuxin City and Central Hospital of Beipiao City,and their data was retrospectively analyzed from Jan.2014to Jan.2015.The time difference from disease onset time to hospital arrival time was recorded as pre-hospital delay time(PDT).The distribution of PDT,ways of hospital arrival and treatment situation were counted in patients from rural and urban areas.Results In treatment ways,there were379patients taken self-visiting doctors,and54patients taken calling“120”emergency system among AMI patients from rural and urban areas.The difference in thrombolysis,PCI and conservative medication had no statistical significance between patients with ST-segment elevation myocardial infarction(STEMI)from urban areas and those from rural areas(P>0.05).The percentage of cases with PDT>720min was the highest in rural patients,and percentage of cases with PDT<30min was the highest in urban patients.The difference in PDT≤720min and PDT>720min had no statistical significance between STMEI patients from urban areas and those from rural areas.The percentage of cases with PDT≤720min was lower in rural patients with non-ST-segment elevation myocardial infarction(non-STEMI)than that in urban non-STEMI patients.Conclusion In rural areas of western Liaoning Province,there is a prevalent delay in treatment in AMI patients.The education of cardiovascular health knowledge and first-aid knowledge of AMI should be promoted and strengthened in general rural population.AMI green channel should be established for shortening PDT,reducing delay in treatment,and winning prime time of reperfusion therapy for patients.