摘要
目的探讨不同就诊方式ST段抬高型心肌梗死（STEMI）患者急诊介入时间延误的差异，并对就诊方式的影响因素进行分析。方法本研究为前瞻性、单中心、观察性研究，设计统一调查表，连续收集2013年9月至2016年6月于河南省人民医院就诊并接受急诊介入治疗的STEMI患者的资料，包括就诊方式、基线资料及急诊介入治疗各时间节点。按就诊方法分为EMS转运组、转诊组和自行组。所有数据经SPSS20．0进行统计分析。结果EMS转运组总缺血时间（229min）较自行组（418min）及转诊组（512min）均较短（均P〈0．05），院前延误时间（55min）较自行组（110min）及转诊组（372min）均较短（均P〈0．05）。转诊组院前延误时间较长，自行组门一囊时间较长，但两组总缺血时间差异无统计学意义（Z=-1．882，P=0．068）。多因素Logistic回归分析就诊方式影响因素：（1）高中及以上学历、公务员、转运距离〉30km的STEMI患者转诊率较高（P〈0．05）；（2）高中、职员、转运距离〈30km、killip分级≥Ⅱ级的STEMI患者EMS就诊率较高（P〈0．05）；（3）个体经营者、非新农合医保、转运距离〈80km、killip分级I级的STEMI患者自行就诊率较高（P〈0．05）。结论不同方式就诊的STEMI患者急诊介入治疗时间延误不同。文化程度、职业、医保类型、转运距离、killip分级与STEMI患者的就诊方式选择有关。
Objective To study the time extended for getting emergency intervention in different modes of transportation and factors influencing the modes of transportation of patients with ST elevation myocardial infarction （STEMI）. Methods A total of 564 consecutive patients with STEMI admitted from September 2013 to June 2016 were enrolled in the study. The clinical data about time consumed for getting emergency intervention and modes of transportation were collected. Results According to the mode of transportation, patients were divided into three groups： emergency care system （EMS） transportation group （n = 96）, self-transportation group （ n = 206 ） and referral group in which the patients were sent in from other hospitals （ n = 262 ）. EMS transportation group had significantly shorter total ischemic time before emergency treatment than self-transportation group （229 min vs. 418 min, P 〈 0. 05 ） and referral group （229 min vs. 512 min, P 〈 0.05 ）, and significantly shorter length of pre-hospital time than self-arrival group （55 min vs. 110 min; P 〈0.05） and referral group （55 min vs. 372 min; P 〈0. 05）. The referral group had longer pre-hospital time and the self-transportation group had longer door-to-balloon time, but there was no difference in total ischemic time between the self-arrival and referral group （Z = -1. 882, P = 0. 068）. Multivariate logistic regression was used to analyze influence factors in mode of transportation： （1） patients characterized with high school or university education, profession of civil service, and their transportation distance more than 30 km were greater in number than referral group （ P 〈 0. 05 ） ; （2） patients identified with senior middle school education, staff member of public sectors or company, their transportation distance less than 30 km, and with killip grade above I1 were more likely to have EMS transport （P 〈 0.05 ）; （3） patients defined as businessmen without taking out new rural cooperative medical insurance, taking up transportation distance less than 80 km, and subjecting to killip grade I had a higher proportion of individuals of this kind taking self-transportation （P 〈 0. 05 ）. Conclusion Mode of transportation is an important factor that affects the time extended to get emergency intervention. Education level, occupation, medical insurance type, transportation distance, killip grade are associated with modes of transport.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第7期756-762,共7页
Chinese Journal of Emergency Medicine
基金
河南省重点科技攻关计划项目（122102310068）
关键词
ST段抬高型心肌梗死
就诊方式
急诊介入时间
ST-elevation myocardial infarction
Mode of transport
Emergency intervention time
