植入型心律转复除颤器二级预防适应证患者的问卷调查

Questionnaire in patients with implantable cardioverter defibrillator secondary prevention indication

目的通过对二级预防适应证的患者进行问卷调查,了解患者发病急救情况、植入型心律转复除颤器(ICD)植入情况及相关影响因素。方法2016年1月至2018年2月在国内20家三甲医院选取满足ICD植入二级预防适应证的住院患者共389例进行了问卷调查,年龄(57.6±15.8)岁,男269例(69.2%,269/389),记录患者的一般人口学特征和临床特征,通过问卷调查,了解患者发病急救情况及接受ICD治疗情况,并分析学历、医保状况以及心功能分级等因素对ICD植入情况的影响。结果389例患者中342例(87.9%,342/389)有持续性室性心动过速(室速)和/或心室颤动(室颤)发作。222例患者发病有目击者,其中112名(50.5%,112/222)目击者打电话给急救系统,急救中心达到现场的平均时间为(23.0±18.5)min。最终植入ICD患者305例(78.4%,305/389),未接受ICD治疗84例;其中30例(35.7%,30/84)患者为经济原因。与未植入ICD组相比,植入ICD患者年龄较大,心功能较好,受教育程度较高;两组间患者的医保情况也有显著差异,植入ICD组有医保比例高(96.2%比81.3%,P<0.05),且医保报销金额明显增多(5.41万比2.69万,P<0.05)。多因素回归分析显示,患者的年龄及当地医保的支付金额与患者接受ICD治疗显著相关。结论国内的急救反应体系中存在急救反应时间过长的问题;对满足ICD植入二级预防适应证的患者,尽管植入ICD的比例有所提高,医疗保险报销比例低仍然是制约ICD植入的重要原因。

Objective To understand the first aid situation of the patients with implantable cardioverter defibrillator(ICD)secondary prevention patients during acute onset,as well as the application of ICD.The effects of education background,medical insurance states and cardiac function classification on ICD implantation condition were analyzed.Methods Patients with ICD secondary prevention indication and their families in 20 Hospitals in China were investigated by questionnaire from June,2016 to February,2018.In addition,the patients basic information and clinical characteristics were also collected.Results There were 389 patients enrolled in this study,including 342 patients(88%,342/389)had history of sustained ventricular tachycardia or ventricular fibrillation events.Two hundred and twenty-two patients had witnesses at the time of onset,112 witnesses(50.5%,112/222)called the emergency system.The average emergency reaction time was(23.0±18.5)minutes.Eight-four patients refused to accept ICD therapy,30 of them were economic reasons(35.7%,30/84).Compared with the group without ICD implantation,the patients who accepted ICD implantation were older,with better cardiac function and higher education,as well as the better Medicare insurance.Logistic regression analysis showed that both age and medical insurance were related to the acceptance of ICD implantation.Conclusion The emergency response time is still a problem in the first aid in China.The lack of medical insurance is the main reason that restricts ICD implantation.