急性心肌梗死病人就医决策延迟影响因素的系统评价

A systematic review of influencing factors of delayed medical decision-making in patients with acute myocardial infarction

[目的]系统评价国内外急性心肌梗死病人就医决策延迟的影响因素。[方法]计算机检索国内外重要数据库,收集所有关于急性心肌梗死病人就医决策延迟影响因素的研究,检索时限均为建库至2018年12月31日,进行Meta分析或描述性分析。[结果]共纳入16项描述性研究,3项病例对照研究,1项前瞻性研究文献,共15518例病人。老年及女性等社会人口学因素、在家发病等社会因素、有心肌梗死病史等临床因素、认知与情感反应、态度与应对、否认等其他心理因素与病人延迟就医有关。[结论]现有证据显示,为减少病人延迟,呼吁社区与医院积极开展健康宣教包括疾病相关知识、症状识别方法等,加强病人急性心肌梗死发病后积极主动就医的意识;社会及家庭应该给予老年与女性急性心肌梗死病人更多的社会经济及情感支持;急性心肌梗死病人的心理健康状态与其是否积极就医有密切的关系,因而医护人员应该全方位地关注急性心肌梗死病人。

Objective:To systematically evaluate the influencing factors of delayed decision-making in patients with acute myocardial infarction in China and abroad.Methods:The important databases in China and abroad were retrieved by computer.And all studies on influencing factors of delayed decision-making in patients with acute myocardial infarction were collected.The retrieval time was from the inception to December 31,2018.Then the Meta-analysis or descriptive analysis were carried out.Results:A total of 16 descriptive studies,3 case-control studies and 1 prospective study were included,involving 15518 patients.The results showed that social demographic factors such as the elderly and female;social factors such as home onset;clinical factors such as history of myocardial infarction;cognitive and emotional response;attitude and coping;denial and other psychological factors were related to delayed medical treatment.Conclusions:In order to reduce patient delays,community and hospital should actively carry out health education,including disease-related knowledge,symptoms identification methods and so on,so as to strengthen patients′awareness of active medical treatment after the onset of AMI.The society and family should provide more social,economic and emotional support to elderly and female patients with acute myocardial infarction.The mental health status of patients with acute myocardial infarction is closely related to whether they actively seek medical treatment.Therefore,medical staff should pay attention to patients with acute myocardial infarction in an all-round way.