胸痛中心模式下急性ST段抬高型心肌梗死患者院外延迟时间影响因素分析

Influencing factors of pre-hospital delay in patients with acute ST segment elevation myocardial infarction under chest pain center mode

目的探讨县域胸痛中心模式下影响急性ST段抬高型心肌梗死(STEMI)院外延迟影响因素,为缩短院外延迟时间制定合理的干预措施提供理论依据。方法以2018年11月—2020年8月来滕州市中心人民胸痛中心就诊的358例急性STEMI患者为研究对象,分析院外延迟时间影响因素及院外延迟对主要不良心血管事件(MACE)、住院天数的影响。结果358例急性STEMI患者院外延迟中位数时间130(67,242)min,院外延迟的影响因素:疼痛程度0~Ⅰ级[OR=1.975,95%CI(1.258~3.10),P=0.003],居住城区[OR=0.389,95%CI(0.23~0.66),P<0.001],乡镇转院[OR=2.711,95%CI(1.274~5.768),P=0.01],归结为心脏原因[OR=0.221,95%CI(0.138~0.352),P<0.001],发病时间(12:00~17:59)[OR=0.529,95%CI(0.287~0.976),P=0.042]。院外延迟时间≤120 min组与>120 min组相比,MACE发生率差异有统计学意义(χ^(2)=4.489,P=0.034),住院天数差异无统计学意义(t=0.067,P=0.947)。结论疼痛程度0~Ⅰ级、乡镇居住、乡镇转院、症状未归因与心脏病是院外延迟危险因素,疼痛程度Ⅱ~Ⅲ级、城区居住、EMS、症状归因与心脏病、发病时间段(12:00—17:59)是院外延迟的保护因素,缩短院外延迟时间,可降低MACE发生。

Objective Explore the influencing factors of pre-hospital delay in patients with acute ST segment elevation myocardial infarction(STEMI)under the county chest pain center mode,and to provide theoretical basis for shortening the pre-hospital delay and formulating reasonable intervention measures.Methods 358 patients with acute STEMI who came to Tengzhou Central People's chest pain center from November 2018 to August 2020 were selected as the research objects.The influencing factors of pre-hospital delay time and the influence of pre-hospital delay on MACE and length of stay were analyzed.Results The median pre-hospital delay time of 358 patients with acute STEMI was 130(67,242)min.Influencing factors of pre-hospital delay:Pain degree:grade 0~Ⅰ[OR=1.975,95%CI(1.258~3.10),P=0.003];living in urban area[OR=0.389,95%CI(0.23~0.66),P<0.001];township hospital transfer[OR=2.711,95%CI(1.274~5.768),P=0.01];attributed to cardiac causes[OR=0.221,95%CI(0.138~0.352),P<0.001];onset time(12:00~17:59)[OR=0.529,95%CI(0.287~0.976),P=0.042].There was significant difference in MACE between the group with pre-hospital delay time≤120min and the group with pre-hospital delay time>120 min(χ^(2)=4.489,P=0.034),but there was no significant difference in the length of stay(t=0.067,P=0.947).Conclusion The risk factors of pre-hospital delay were pain degree 0~Ⅰ,township residence,township transfer,failure to attribute symptoms to heart disease.The protective factors of pre-hospital delay were pain degree Ⅱ~Ⅲ,urban residence,EMS,attribute symptoms to heart disease,onset time(12:00~17:59).Shortening the pre-hospital delay can reduce the incidence of MACE.