急性心肌梗死患者住院延迟情况及影响因素分析

Influencing factors of delayed hospitalization in patients with acute myocardial infarction

目的:了解石河子大学第一附属医院急性心肌梗死(AMI)患者住院延迟情况并分析其影响因素。方法:纳入石河子大学第一附属医院2016-01-01-2017-12-31的AMI患者1 069例,按发病至住院时间>12 h及≤12 h分为住院延迟组与住院未延迟组。比较两组患者住院延迟的临床后果,采用单因素及多因素logistic回归分析住院延迟的影响因素。结果:住院延迟组患者行PCI(33.9%∶65.0%)、急诊PCI(7.0%∶56.4%)及溶栓(1.2%∶3.7%)比例均较住院未延迟组患者降低,院内死亡(11.4%∶7.1%)、左心室射血分数(LVEF)<50%(39.0%∶26.9%)、心功能3或4级(16.4%∶10.1%)及乳头肌功能失调或断裂(1.8%∶0.1%)比例均较住院未延迟组患者升高,以上差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,AMI患者住院延迟的独立危险因素包括高龄、女性、农民、来自团场、非ST段抬高型心肌梗死(NSTEMI)、呼吸系统疾病,保护因素为大学及以上文化程度、冠状动脉支架植入史(均P<0.05)。结论:本院约有1/3的AMI患者住院延迟,这些患者再灌注比例低,院内临床后果差;住院延迟的影响因素为高龄、女性、农民、来自团场、NSTEMI及合并呼吸系统疾病。

Objective:To investigate the delayed hospitalization of patients with acute myocardial infarction(AMI)in the First Affiliated Hospital of Shihezi University and analyze the influencing factors.Method:A total of 1069 patients with AMI who were admitted in the First Affiliated Hospital of Shihezi University from January 1,2016 to December 31,2017 were enrolled.All patients were divided into delayed hospitalization group(>12 h)and non-delayed hospitalization group(≤12 h)according to the time from the onset of AMI to hospitalization.Clinical consequences of delayed hospitalization were compared between two groups,and influencing factors of delayed hospitalization were analyzed by univariate and multivariate logistic regression.Result:The proportion of undergoing PCI(33.9%vs 65.0%),emergency PCI(7.0%vs 56.4%)and thrombolysis(1.2%vs 3.7%)were lower in delayed hospitalization group than those in non-delayed hospitalization group(all P<0.05).The proportion of in-hospital death(11.4%vs 7.1%),left ventricular ejection fraction(LVEF)<50%(39.0%vs 26.9%),cardiac function grade 3 or 4(16.4%vs 10.1%)and papillary muscle dysfunction or fracture(1.8%vs 0.1%)were higher in delayed hospitalization group than those in non-delayed hospitalization group(all P<0.05).Multivariate logistic regression analysis showed that independent risk factors for delayed hospitalization included advanced age,female,peasant,group farm,non-ST-segment elevation myocardial infarction(NSTEMI),respiratory disease,and protective factors included college degrees or above and history of coronary stent implantation(all P<0.05).Conclusion:About one-third of the patients have the record of delayed hospitalization,low proportion of coronary reperfusion and poor clinical consequence.The influencing factors for delayed hospitalization include advanced age,women,peasant,group farm,NSTEMI and respiratory disease.