摘要
目的分析急性ST段抬高型心肌梗死患者发病至呼叫120的流行病学特点和临床特征,探讨患者发病至呼救延迟的影响因素。方法采集天津市急救中心2020年接诊救治的急性ST段抬高型心肌梗死患者的临床资料,将1238例纳入为研究对象,进行回顾性分析,把患者发病至呼叫120的时长分为≤30 min和>30 min 2组,以年龄、性别、发病时间、发病时症状、首次医疗接触心电图、血压、血氧饱和度等为研究变量,单因素及多因素logistic二元回归分析呼救延迟的影响因素。结果患者发病平均年龄66.5岁(66.5±13.5),其中年龄<69岁730例(59%),男性913例(73.7%),居住市内六区759例(61.2%),既往有心脑血管疾病或外周血管疾病625例(50.5%),呼救时主要症状为胸背痛815例(65.8%),发病时间在21:00~7:00507例(40.9%),发病在周末375例(30.3%),急性下壁心肌梗死616例(49.8%),首次医疗接触收缩压<120 mmHg 595例(48.1%),血氧饱和度<90%150例(12.1%),583例(47%)的患者院前发病至呼叫120时长>30min;研究结果提示,女性(优势比OR=1.406;95%CI:1.011~1.956;P=0.043),年龄>69岁(OR=1.635;95%CI:1.213~2.203;P=0.001),首次医疗接触收缩压≥120 mmHg(OR=1.501;95%CI:1.124~2.004;P=0.006)是导致患者发病至呼叫120延迟的危险性因素;发病时间在7:00~21:00(OR=0.733;95%CI:0.553~0.972;P=0.031),呼叫120时主要症状为意识障碍(OR=0.442;95%CI:0.205~0.953;P=0.037)是促使患者及时呼叫120的保护性因素。结论女性患者,年龄>69岁,发病时间在21:00~7:00,呼叫120时主要症状非意识障碍、发病时收缩压≥120 mmHg是急性ST段抬高型心肌梗死患者呼救延迟的独立危险因素。需要重点关注、加强宣教,以期尽早识别急性心肌梗死、及时呼救、减少致死致残。
Objective This study focused on the delay of patients,analyzed the epidemiological and clinical characteristics of patients with acute ST segment elevation myocardial infarction from onset to call 120,and discussed the influencing factors of the delay of patients from onset to call 120.Methods The clinical data of 1238 patients with acute ST segment elevation myocardial infarction treated at Tianjin emergency Center in 2020 were collected and retrospectively analyzed.Patients with chest pain up to 120 minutes were divided into two groups based on the duration from onset to call 120:≤30 minutes and>30 minutes.Using age,gender,onset time,symptoms at onset,blood pressure at onset,and oxygen saturation as research variables,univariate and multivariate logistic regression analyses were performed to identify the influencing factors of call delay.Results The average age onset was(66.5±13.5)years old,730 cases(59%)were≤69 years old,913(73.7%)were male,and 759(61.2%)lived in six districts of the city.There were 625 cases(50.5%)with cardio-cerebrovascular disease or peripheral vascular disease,815(65.8%)with chest and back pain when calling for help,507(40.9%)with disease onset at 21:00~7:00,375(30.3%)with disease onset on weekends,490(49.8%)with acute inferior myocardial infarction,595(48.1%)with first medical contact systolic blood pressure<120 mmHg,150(12.1%)with blood oxygen saturation<90%,and 583(47%)who took more than 30 minutes from prehospital onset to call 120.The results showed that female gender[odds ratio(OR)=1.406;95%CI:1.011~1.956;P=0.043],age>69 years old(OR=1.635;95%CI:1.213~2.203;P=0.001),and first medical contact systolic blood pressure≥120 mmHg(OR=1.501;95%CI:1.124~2.004;P=0.006)were risk factors for delay from onset to call 120,while onset time of 7:00~21:00(OR=0.733;95%CI:0.553~0.972;P=0.031)and disturbance of consciousness as the main symptom when calling 120(OR=0.442;95%CI:0.205~0.953;P=0.037)were protective factors for patients to call 120 in time.Conclusion Female gender,age>69 years old,ons
作者
赵彦叶
顾乃刚
张亮
Zhao Yanye;Gu Naigang;Zhang Liang(Tianjin Emergency Center,Tianjin 300011,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2022年第9期857-862,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
急性ST段抬高型心肌梗死
发病
呼救延迟
首次医疗接触
Acute ST segment elevation myocardial infarction
Onset
Delayed call for help
First medical contact
