首发急性心肌梗死患者就医决策延迟影响因素分析

Relationship between delayed medical decision making and disease perception and coping style in patients with first-episode acute myocardial infarction

目的探讨首发急性心肌梗死患者就医决策延迟影响因素分析。方法采取便利抽样法,选取2022年1月—2023年10月郑州大学第二附属医院收治的首发急性心肌梗死患者为调查对象,采用一般资料调查表,疾病感知量表、应对方式量表调查,采用Pearson相关分析就医决策延迟时间与疾病感知、应对方式间的相关性,采用logistic回归分析首发急性心肌梗死患者就医决策延迟危险因素。结果共调查158例首发急性心肌梗死患者,就医决策延迟时间为(129.38±32.38)min,本研究以就医决策时间60 min为界,其中就医决策延迟82例,发生率53.95%;首发急性心肌梗死患者就医决策延迟时间与疾病感知呈负相关(r=-0.461,P<0.001),就医决策延迟与应对方式中面对维度呈负相关(r=-0.495,P<0.001),与应对方式中回避、屈服维度呈正相关(r=0.414、0.429,P<0.001);logistic回归分析结果显示,疾病感知得分低(OR=4.031,95%CI:1.766~9.200)、面对得分低(OR=6.190,95%CI:1.783~21.490)、回避和屈服得分高(OR=2.489、2.321,95%CI:1.327~4.670、1.392~3.871)、普通门诊就诊(OR=2.517,95%CI:1.342~4.722)、夜间发病(OR=2.396,95%CI:1.403~4.092)是急性心肌梗死患者就医延迟的危险因素。结论首发急性心肌梗死患者就医决策延迟不容乐观,疾病感知、应对方式与就医决策延迟有关,且疾病感知、应对方式、就诊途径及发病时间为影响因素,临床应重点关注急性心肌梗死高危群体,有利于制定针对性干预措施,降低就医决策延迟。

Objective To investigate the relationship between the delay in seeking medical treatment for initial acute myocardial infarction and the perception and coping strategies of the disease.Methods A total of 158 patients with initial acute myocardial infarction admitted to the Second Affiliated Hospital of Zhengzhou University from January 2022 to October 2023 were selected using convenience sampling.Pearson correlation analysis was used to examine the correlation between the delay in seeking medical treatment and disease perception,as well as coping strategies.Logistic regression analysis was conducted to identify the risk factors for the delay in seeking medical treatment for initial acute myocardial infarction.Results The findings revealed that the delay in seeking medical treatment for initial acute myocardial infarction was(129.38±32.38)minutes,with 82 cases(53.95%)experiencing a delay exceeding 60 minutes.The study found a negative correlation between the delay in seeking medical treatment and disease perception(r=-0.461,P<0.001),as well as a negative correlation between the delay and the confrontational dimension of coping strategies(r=-0.495,P<0.001),and a positive correlation with the avoidance and yielding dimensions of coping strategies(r=0.414,0.429,P<0.001).The logistic regression analysis results indicate that low disease perception score(OR=4.031,95%CI:1.766-9.200),low coping score(OR=6.190,95%CI:1.783-21.490),high avoidance and compliance scores(OR=2.489,2.321,95%CI:1.327-4.670,1.392-3.871),normal outpatient visits(OR=2.517,95%CI:1.342-4.722),and onset of illness during the night(OR=2.396,95%CI:1.403-4.092).Conclusion The delay in seeking medical treatment for initial acute myocardial infarction is concerning,and it is associated with disease perception and coping strategies.Disease perception,coping strategies,medical treatment pathways,and onset time are influential factors,and clinical attention should be focused on the high-risk group for acute myocardial infarction to develop targeted intervention measures and reduce the delay in seeking medical treatment.