2018 年第 2 期 第 13 卷

辽北贫困地区急性ST段抬高型心肌梗死院前延迟就诊相关因素分析

作者：王永栾波赵宏伟王莉莉于国宁孙佳禾肖克令李媛张晓娇侯爱洁

英文作者：

单位：110016沈阳，辽宁省人民医院中国医科大学人民医院心血管病治疗中心(王永、栾波、赵宏伟、王莉莉、孙佳禾、肖克令、李媛、张晓娇、侯爱洁),科教处（于国宁）

英文单位：

关键词：急性ST段抬高型心肌梗死；辽北地区；发病至首次医疗接触时间；院前延迟就诊

英文关键词：

• 摘要：

• 目的    探讨辽北贫困地区急性ST段抬高型心肌梗死(STEMI)患者就诊延迟的主要影响因素，分析并制定相应的对策。方法    纳入辽北贫困地区7家县医院共635例STEMI患者，根据发病至首次医疗接触时间（S2T）将患者分为S2T＜3 h组、S2T 3~12 h组、S2T>12 h组。7家县医院参与研究的医师统一接受培训，填写我中心印制的调查表,详细记录3组患者的基本人口学及临床特征、环境因素、行为因素、住院期间不良心血管事件发生情况。结果    S2T<3 h组125例（19.7%），S2T 3~12 h组120例（18.9%），S2T>12 h组390例（61.4%），3组患者的平均S2T时间分别为(2.7±1.2)、(10.9±2.6)、(24.3±6.4)h，平均年龄分别为（56±6）、（59±6）、（64±9）岁，组间比较差异均有统计学意义（均P<0.01）,3组患者有医保、教育程度小学以下学历、症状典型、将症状理解为心脏病、担心住院费用、未呼叫120、夜间发病的比例差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析提示：年龄≥65岁、小学以下学历、症状不典型、担心住院费用、未呼叫120为患者就诊延迟的独立预测因素(均P<0.05)。S2T<3 h组患者住院期间不良心血管事件发生率明显低于S2T 3~12 h组和S2T>12 h组（均P<0.05）。 结论辽北贫困地区民众急救意识差，延迟就诊率极高，因此普及急性心肌梗死急救知识，提高民众急救自救意识，建设完善合理的急性心肌梗死三级救治体系具有非常重要的意义。

• Influence factors of prehospital delay of acute ST-segment elevation myocardial infarction in poor areas of northern Liaoning Province

  Wang Yong, Luan Bo, Zhao Hongwei, Wang Lili, Yu Guoning, Sun Jiahe, Xiao Keling, Li Yuan, Zhang Xiaojiao, Hou Aijie

  Treatment Center of Cardiovascular Diseases, People′s Hospital of Liaoning Province, People′s Hospital of China Medical University, Shenyang 110016, China(Wang Y, Luan B, Zhao HW, Wang LL, Sun JH, Xiao KL, Li Y, Zhang XJ, Hou AJ); Department of Science and Education, People′s Hospital of Liaoning Province, People′s Hospital of China Medical University, Shenyang 110016, China(Yu GN)

  Corresponding author: Hou Aijie, Email: houaijie@medmail.com.cn

  【Abstract】Objective    To investigate the influence factors of prehospital delay of acute ST-segment elevation myocardial infarction（STEMI） in poor areas of northern Liaoning Province. Methods    Totally 635 cases of acute STEMI in 7 county hospitals in poor areas of northern Liaoning Province were included in this study, and the patients were divided into 3 groups according to the symptom onset to first medical contact time（S2T）: S2T<3 h group, S2T 3-12 h group and S2T>12 h group. Demographic and clinical features, environmental factors, behavioral factors and in-hospital adverse cardiovascular events were analyzed. Results    There were 125 cases(19.7%) in S2T<3 h group, 120 cases(18.9%) in S2T 3-12 h group and 390 cases(61.4%) in S2T>12 h group. Mean S2T［(2.7±1.2), (10.9±2.6), (24.3±6.4)h］ and mean age［（56±6）, （59±6）, （64±9）years］ had significant differences among 3 groups（all P<0.01）. Incidences of patients having health insurance, below primary school education, typical symptoms, awareness of the heart disease, concerns of hospitalization expenses, not calling 120 and nocturnal infarction attack had significant differences among 3 groups(P<0.05). Multivariate logistic regression analysis showed that age≥65 years, education degree below primary school, atypical symptoms, concerns of hospitalization cost and not calling 120 were independent predictors of prehospital treatment delay(all P<0.05). The incidence rate of adverse cardiovascular events in the patients in S2T<3 h group was significantly lower than that in S2T 3-12 h group and S2T>12 h group (all P<0.05). Conclusions    There is an extremely high prevalence of prehospital delay of acute STEMI in poor areas of northern Liaoning due to the lack of awareness of first aid for acute myocardial infarction. It is urgent to improve the emergency rescue ability and optimize the three-class diagnosis and treatment process.

  【Key words】Acute ST-segment elevation myocardial infarction;Poor areas of northern Liaoning Province;Symptom onset to first medical contact time;Prehospital delay

  【Fund program】Science and Technology Project of Liaoning Province（2014225021）