目的探讨急性心肌梗死患者院前延迟的影响因素,并明确应对策略,旨在缩短院前延迟时间。方法经Pubmed、Embase等十大数据库检索相关文献,用NOS量表评价纳入文献19篇,均为流行病调查研究,以Rev Man 5.3软件进行统计分析。结果通过Meta分...目的探讨急性心肌梗死患者院前延迟的影响因素,并明确应对策略,旨在缩短院前延迟时间。方法经Pubmed、Embase等十大数据库检索相关文献,用NOS量表评价纳入文献19篇,均为流行病调查研究,以Rev Man 5.3软件进行统计分析。结果通过Meta分析将影响因素归纳为3大类。①社会因素:年龄[OR=1.090,95%CI(1.060～1.130),P<0.001]、性别[OR=1.180,95%CI(1.050～1.330),P=0.006]、文化水平[OR=1.410,95%CI(1.190～1.670),P<0.001]、居住地区[OR=1.350,95%CI(0.990～1.840),P=0.060];②临床因素:糖尿病史[OR=1.380,95%CI(1.220～1.560),P<0.001]、心绞痛史[OR=1.370,95%CI=1.050～1.770,P=0.020]、心肌梗死史[OR=1.080,95%CI(0.640～1.830),P=0.760]、PCI史[OR=0.760,95%CI(0.670～0.860),P<0.001];③其他因素:夜间发病[OR=1.630,95%CI(1.340～1.970),P<0.001]、就诊方式[OR=0.640,95%CI(0.570～0.710),P<0.001]、未将症状归因于心脏[OR=3.100,95%CI(1.620～5.940),P<0.001]。结论高龄、女性、糖尿病史、心绞痛史、夜间发病、未将症状归因于心脏是其危险因素,高学历、PCI史、EMS就诊是其保护因素,居住地区、心肌梗死史与急性心肌梗死患者院前延迟无关。采取切实有效地干预措施,能够缩短院前延迟时间,降低患者院外死亡率。展开更多
目的探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考。方法选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系。...目的探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考。方法选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系。结果患者院前时间为135.5(48.3,1735.5)min,其中院前时间≤150 min 253例(51.8%),>150 min(即院前延迟)235例(48.2%);首发症状多为胸背痛[146例(29.9%)],其次为胸前痛124例(25.4%)、腹痛121例(24.8%)。Logistic回归分析发现自觉病情严重程度、胸背痛是院前延迟的保护因素(P<0.01),腹痛、四肢麻木/疼痛是急性主动脉夹层患者院前延迟的危险因素(P<0.05,P<0.01)。结论急性主动脉夹层患者常以胸背痛为首发症状,腹痛与四肢麻木/疼痛非典型症状是导致急性主动脉夹层患者出现院前延迟的主要因素。需对公众加强疾病相关知识的健康教育,早期采取正确的应对方式,积极就医,缩短院前时间。展开更多
Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced sy...Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.展开更多
目的分析急性缺血性脑卒中静脉溶栓治疗院前延误的影响因素。方法通过统一的问卷对甘肃省兰州市某三甲医院2017年1月1日~2018年6月30日收治的267例急性缺血性脑卒中(AIS)患者进行调查。根据是否在发病2 h内送到医院,将患者设置为延误组...目的分析急性缺血性脑卒中静脉溶栓治疗院前延误的影响因素。方法通过统一的问卷对甘肃省兰州市某三甲医院2017年1月1日~2018年6月30日收治的267例急性缺血性脑卒中(AIS)患者进行调查。根据是否在发病2 h内送到医院,将患者设置为延误组和非延误组,对影响脑卒中治疗的院前因素进行相关因素分析。结果(1)两组患者的基线资料中教育程度、医保类型差异有统计学意义(P<0.05);(2)两组患者临床特征中意识障碍及预后比较,差异具有统计学意义(P<0.05);(3)影响脑卒中患者延误的多因素分析显示:来院途径、患者受教育程度、NIHSS(National Institute of Health stroke scale)评分、脑卒中病史是影响患者2 h到达医院的独立因素。结论通过急救系统与患者受教育程度可有效缩短DNT(Door-to-needle time)时间,对广大群众进行脑卒中知识的普及,可使更多的AIS患者得到有效治疗。展开更多
文摘目的探讨急性心肌梗死患者院前延迟的影响因素,并明确应对策略,旨在缩短院前延迟时间。方法经Pubmed、Embase等十大数据库检索相关文献,用NOS量表评价纳入文献19篇,均为流行病调查研究,以Rev Man 5.3软件进行统计分析。结果通过Meta分析将影响因素归纳为3大类。①社会因素:年龄[OR=1.090,95%CI(1.060～1.130),P<0.001]、性别[OR=1.180,95%CI(1.050～1.330),P=0.006]、文化水平[OR=1.410,95%CI(1.190～1.670),P<0.001]、居住地区[OR=1.350,95%CI(0.990～1.840),P=0.060];②临床因素:糖尿病史[OR=1.380,95%CI(1.220～1.560),P<0.001]、心绞痛史[OR=1.370,95%CI=1.050～1.770,P=0.020]、心肌梗死史[OR=1.080,95%CI(0.640～1.830),P=0.760]、PCI史[OR=0.760,95%CI(0.670～0.860),P<0.001];③其他因素:夜间发病[OR=1.630,95%CI(1.340～1.970),P<0.001]、就诊方式[OR=0.640,95%CI(0.570～0.710),P<0.001]、未将症状归因于心脏[OR=3.100,95%CI(1.620～5.940),P<0.001]。结论高龄、女性、糖尿病史、心绞痛史、夜间发病、未将症状归因于心脏是其危险因素,高学历、PCI史、EMS就诊是其保护因素,居住地区、心肌梗死史与急性心肌梗死患者院前延迟无关。采取切实有效地干预措施,能够缩短院前延迟时间,降低患者院外死亡率。
文摘目的探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考。方法选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系。结果患者院前时间为135.5(48.3,1735.5)min,其中院前时间≤150 min 253例(51.8%),>150 min(即院前延迟)235例(48.2%);首发症状多为胸背痛[146例(29.9%)],其次为胸前痛124例(25.4%)、腹痛121例(24.8%)。Logistic回归分析发现自觉病情严重程度、胸背痛是院前延迟的保护因素(P<0.01),腹痛、四肢麻木/疼痛是急性主动脉夹层患者院前延迟的危险因素(P<0.05,P<0.01)。结论急性主动脉夹层患者常以胸背痛为首发症状,腹痛与四肢麻木/疼痛非典型症状是导致急性主动脉夹层患者出现院前延迟的主要因素。需对公众加强疾病相关知识的健康教育,早期采取正确的应对方式,积极就医,缩短院前时间。
文摘Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.
文摘目的分析急性缺血性脑卒中静脉溶栓治疗院前延误的影响因素。方法通过统一的问卷对甘肃省兰州市某三甲医院2017年1月1日~2018年6月30日收治的267例急性缺血性脑卒中(AIS)患者进行调查。根据是否在发病2 h内送到医院,将患者设置为延误组和非延误组,对影响脑卒中治疗的院前因素进行相关因素分析。结果(1)两组患者的基线资料中教育程度、医保类型差异有统计学意义(P<0.05);(2)两组患者临床特征中意识障碍及预后比较,差异具有统计学意义(P<0.05);(3)影响脑卒中患者延误的多因素分析显示:来院途径、患者受教育程度、NIHSS(National Institute of Health stroke scale)评分、脑卒中病史是影响患者2 h到达医院的独立因素。结论通过急救系统与患者受教育程度可有效缩短DNT(Door-to-needle time)时间,对广大群众进行脑卒中知识的普及,可使更多的AIS患者得到有效治疗。
