急性心肌梗死患者诊治院前延误的相关因素
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摘要
目的:研究急性心肌梗死(acute myocardial infarction,AMI)患者院前延误的现状,并分析相关影响因素。方法:纳入2014年4月至2016年4月南京医科大学附属无锡第二医院因AMI就诊的患者240例,年龄18~89岁。收集并记录患者基本情况(年龄、性别)、临床资料(发病情况、就诊经过、来院方式、既往史等)等信息,通过半封闭式调查患者求医延迟及首次医疗接触选择倾向性的主观原因。结果:在240例患者中,32.92%发生院前延误,7.9%就诊院前时间超过24 h。Logistic回归分析显示非典型症状、归因错误、糖尿病及未呼叫急诊医疗(emergency medical services,EMS)是院前延误发生的危险因素;非典型症状、糖尿病病史是发生归因错误的危险因素。结论:AMI患者对症状分析错误属常见现象,典型症状有助于患者进行正确归因,降低院前延误的风险。EMS是AMI患者最佳转运方式,可缩短患者就诊院前时间。
Objective: To study the status of pre-hospital delay in patients with acute myocardial infarction(AMI), and to analyze the related factors, focusing on analysis of influencing factors of patients. Methods: A total of 240 patients aged 18–89 years who were admitted to the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University from April 2014 to April 2016 were enrolled in the study. Then we collected and recorded the following information about the patient: the basic situation(age and sex), clinical data, semi-closed survey patients' reasons for delay to seek medical help and reasons for choice of first medical contact. Results: In 240 cases, 32.92% of patients had pre-hospital delay, 12.08% of patients visited hospital 24 h after the onset of symptoms. Logistic regression analysis showed that atypical symptoms, not to attribute to true cause diabetes mellitus and not called emergency medical services(EMS) were risk factors for prehospital delay. Atypical symptoms and a history of diabetes were risk factors for incorrect attribution. Conclusion: In patients with AMI, misinterpretation of symptoms is common, and typical symptoms are tended to correct attribution of symptoms and reduce the risk of pre-hospital delay. EMS is the best way to transport patients with AMI, which can shorten the time before admission.
Objective: To study the status of pre-hospital delay in patients with acute myocardial infarction(AMI), and to analyze the related factors, focusing on analysis of influencing factors of patients. Methods: A total of 240 patients aged 18–89 years who were admitted to the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University from April 2014 to April 2016 were enrolled in the study. Then we collected and recorded the following information about the patient: the basic situation(age and sex), clinical data, semi-closed survey patients' reasons for delay to seek medical help and reasons for choice of first medical contact. Results: In 240 cases, 32.92% of patients had pre-hospital delay, 12.08% of patients visited hospital 24 h after the onset of symptoms. Logistic regression analysis showed that atypical symptoms, not to attribute to true cause diabetes mellitus and not called emergency medical services(EMS) were risk factors for prehospital delay. Atypical symptoms and a history of diabetes were risk factors for incorrect attribution. Conclusion: In patients with AMI, misinterpretation of symptoms is common, and typical symptoms are tended to correct attribution of symptoms and reduce the risk of pre-hospital delay. EMS is the best way to transport patients with AMI, which can shorten the time before admission.
引文
1.Ng S,Ottervanger JP,van’t Hof AW,et al.Impact of ischemic time on post-infarction left ventricular function in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention[J].Int J Cardiol,2013,165(3):523-527.
2 .Guerchicoff A,Brener SJ,Maehara A,et al.Impact of delay to reperfusion on reperfusion success,infarct size,and clinical outcomes in patients with ST-segment elevation myocardial infarction:the INFUSE-AMI Trial(INFUSE-Anterior Myocardial Infarction)[J].JACC Cardiovasc Interv,2014,7(7):733-740.
3 .Vemulapalli S,Zhou Y,Gutberlet M,et al.Importance of total ischemic time and preprocedural infarct-related artery blood flow in predicting infarct size in patients with anterior wall myocardial infarction(from the CRISP-AMI Trial)[J].Am J Cardiol,2013,112(7):911-917.
4 .Goel K,Pinto DS,Gibson CM.Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention:a systematic review[J].Am Heart J,2013,165(4):451-467.
5 .Makam RP,Erskine N,Yarzebski J,et al.Decade long trends(2001-2011)in duration of pre-hospital delay among elderly patients hospitalized for an acute myocardial infarction[J].J Am Heart Assoc,2016,5(4):e002664.
6 .Moy E,Barrett M,Coffey R,et al.Missed diagnosis of acute myocardial infarction in the emergency department:variation by patient and facility characteristic[J].Diagnosis(Berl),2015,2(1):29-40.
7 .Roffi M,Patrono C,Collet JP,et al.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation:task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.
8 .董海,荆全民,徐凯,等.胸痛中心的成立对急性ST段抬高型心肌梗死患者救治的影响[J].解放军医学杂志,2016,41(6):452-455.DONG Hai,JING Quanmin,XU Kai,et al.Role of the chest pain center in treatment of patients with acute ST-elevated myocardial infarction[J].Medical Journal of Chinese People’s Liberation Army,2016,41(6):452-455.
9 .Ting HH,Chen AY,Roe MT,et al.Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction[J].Arch Intern Med,2010,170(20):1834-1841.
10 .Bett JH,Tonkin AM,Thompson PL,et al.Failure of current public educational campaigns to impact on the initial response of patients with possible heart attack[J].Intern Med J,2005,35(5):279-282.
11 .Sheiban I,Fragasso G,Lu C,et al.Influence of treatment delay on long-term left ventricular function in patients with acute myocardial infarction successfully treated with primary angioplasty[J].Am Heart J,2001,141(4):603-609.
12 .Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2018,39(2):119-177.
13 .?ngerud KH,Brulin C,N?slund U,et al.Longer pre-hospital delay in first myocardial infarction among patients with diabetes:An analysis of 4266 patients in the northern Sweden MONICA Study[J].BMC Cardiovasc Disord,2013,13:6.
14 .Dodson JA,Geda M,Krumholz HM,et al.Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI(SILVER-AMI)study[J].BMC Health Serv Res,2014,14:506.
15 .Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction[J].J Am Coll Cardiol,2012,60(16):1581-1598.
16 .Ruddox V,Mathisen M,Otterstad JE.Prevalence and prognosis of nonspecific chest pain among patients hospitalized for suspected acute coronary syndrome—a systematic literature search[J].BMC Med,2012,10:58.
17 .Terkelsen CJ,S?rensen JT,Maeng M,et al.System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention[J].JAMA,2010,304(7):763-771.
18 .Kirchberger I,Heier M,Wende R,et al.The patient’s interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment:the MONICA/KORA Myocardial Infarction Registry[J].Clin Res Cardiol,2012,101(11):909-916.
19 .Mourad G,Alwin J,Str?mberg A,et al.Societal costs of non-cardiac chest pain compared with ischemic heart disease—a longitudinal study[J].BMC Health Serv Res,2013,13:403.
2 .Guerchicoff A,Brener SJ,Maehara A,et al.Impact of delay to reperfusion on reperfusion success,infarct size,and clinical outcomes in patients with ST-segment elevation myocardial infarction:the INFUSE-AMI Trial(INFUSE-Anterior Myocardial Infarction)[J].JACC Cardiovasc Interv,2014,7(7):733-740.
3 .Vemulapalli S,Zhou Y,Gutberlet M,et al.Importance of total ischemic time and preprocedural infarct-related artery blood flow in predicting infarct size in patients with anterior wall myocardial infarction(from the CRISP-AMI Trial)[J].Am J Cardiol,2013,112(7):911-917.
4 .Goel K,Pinto DS,Gibson CM.Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention:a systematic review[J].Am Heart J,2013,165(4):451-467.
5 .Makam RP,Erskine N,Yarzebski J,et al.Decade long trends(2001-2011)in duration of pre-hospital delay among elderly patients hospitalized for an acute myocardial infarction[J].J Am Heart Assoc,2016,5(4):e002664.
6 .Moy E,Barrett M,Coffey R,et al.Missed diagnosis of acute myocardial infarction in the emergency department:variation by patient and facility characteristic[J].Diagnosis(Berl),2015,2(1):29-40.
7 .Roffi M,Patrono C,Collet JP,et al.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent st-segment elevation:task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.
8 .董海,荆全民,徐凯,等.胸痛中心的成立对急性ST段抬高型心肌梗死患者救治的影响[J].解放军医学杂志,2016,41(6):452-455.DONG Hai,JING Quanmin,XU Kai,et al.Role of the chest pain center in treatment of patients with acute ST-elevated myocardial infarction[J].Medical Journal of Chinese People’s Liberation Army,2016,41(6):452-455.
9 .Ting HH,Chen AY,Roe MT,et al.Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction[J].Arch Intern Med,2010,170(20):1834-1841.
10 .Bett JH,Tonkin AM,Thompson PL,et al.Failure of current public educational campaigns to impact on the initial response of patients with possible heart attack[J].Intern Med J,2005,35(5):279-282.
11 .Sheiban I,Fragasso G,Lu C,et al.Influence of treatment delay on long-term left ventricular function in patients with acute myocardial infarction successfully treated with primary angioplasty[J].Am Heart J,2001,141(4):603-609.
12 .Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2018,39(2):119-177.
13 .?ngerud KH,Brulin C,N?slund U,et al.Longer pre-hospital delay in first myocardial infarction among patients with diabetes:An analysis of 4266 patients in the northern Sweden MONICA Study[J].BMC Cardiovasc Disord,2013,13:6.
14 .Dodson JA,Geda M,Krumholz HM,et al.Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI(SILVER-AMI)study[J].BMC Health Serv Res,2014,14:506.
15 .Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction[J].J Am Coll Cardiol,2012,60(16):1581-1598.
16 .Ruddox V,Mathisen M,Otterstad JE.Prevalence and prognosis of nonspecific chest pain among patients hospitalized for suspected acute coronary syndrome—a systematic literature search[J].BMC Med,2012,10:58.
17 .Terkelsen CJ,S?rensen JT,Maeng M,et al.System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention[J].JAMA,2010,304(7):763-771.
18 .Kirchberger I,Heier M,Wende R,et al.The patient’s interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment:the MONICA/KORA Myocardial Infarction Registry[J].Clin Res Cardiol,2012,101(11):909-916.
19 .Mourad G,Alwin J,Str?mberg A,et al.Societal costs of non-cardiac chest pain compared with ischemic heart disease—a longitudinal study[J].BMC Health Serv Res,2013,13:403.