摘要
目的评估“患者家属签署知情同意书”这一中国的客观现实对STEMI患者急诊冠脉血运重建时间的影响及其影响因素分析,旨在为进一步有效缩短急诊冠脉血运重建时间提供科学依据。方法连续收集2016年6月1日至2017年12月31日期间首诊于河南省人民医院并接受急诊冠脉介入治疗的226例急性ST段抬高型心肌梗死(STEMI)患者的完整病历资料。观察指标包括:(1)患者基线资料;(2)急诊冠脉血运重建各时间节段:总缺血时间、“门-囊”时间、“门-字”时间、“字-囊”时间;(3)患者家属的资料。采用SPSS 20.0软件进行统计学分析,多重线性回归分析“门-字”时间延误的影响因素,以P < 0.05为差异具有统计学意义。结果本研究226例首诊于本院的STEMI患者的年龄为(55.23±10.80)岁,男性181例(80.1%)。226例STEMI患者,总缺血时间、“门-囊”时间、“门-字”时间、“字-囊”时间中位数分别为312 min、166 min、82 min、80 min。“门-字”时间在“门-囊”时间及总缺血时间中所占的比例分别为50%、28.5%。多重线性回归分析“门-字”时间延误的因素,结果表明,直系家属个数(P < 0.01)、家属文化程度在初中及以下(P = 0.010)、高中/中专(P = 0. 029)、家属顾虑医疗费用太高(P = 0.020)、等待更多亲属共同商议(P = 0.001)、咨询其他医务人员(P = 0.022)是“门-字”时间延误的危险因素,家属居住地为城市(P = 0.048)是“门-字”时间延误的保护因素。结论“门-字”时间过长是中国急诊冠脉血运重建实践的现实,需要引起高度重视。患者家属的文化程度、居住地、直系家属个数、家属的心理因素及处理方式等均对“门-字”时间延误产生影响。中国的急诊冠脉血运重建时间,在强调“门-囊”时间的同时,也应重视“字-囊”时间。
Objective To investigate the delay of door to signature time in primary percutaneous coronary intervention (PCI) and its influence in patients with ST segment elevation myocardial infarction (STEMI), therefore to provide a scientific basis for further effective shortening the time of primary PCI in patients with STEMI. Methods A total of 226 patients who diagnosed with STEMI and underwent primary PCI at Henan Provincial People's Hospital from June 2016 to December 2017 were enrolled in the study. Observation indicators include:(1) baseline data of patients;(2) time segments in primary PCI: total ischemic time (TIT), door to balloon time (DTΒT), door-to-signature time (DTST), signature to balloon time (STΒT);(3) the demographic characteristics of the family members who signed informed consent;and (4) the psychological factors and coping strategies of family members before signing informed consent. All data was analyzed using SPSS software (version 22.0). Multiple linear regression analysis was used to analyze the influencing factors of delay of DTST. A P < 0.05 was considered statistically significant. Results In this study, 226 patients with STEMI who were first diagnosed in our hospital had a mean age of 55.23±10.80 years, and 181 (80.1%) were male. The median of TIT, DTΒT, DTST, STΒT were 312 min, 166 min, 82 min, and 80 min. The ratio of DTST in DTBT and TIT was 50% and 28.5%, respectively. The multiple linear regression analysis showed that the number of direct family members (P < 0.001), the degree of educational in middle school and below (P = 0.010), high school/technical secondary school (P = 0. 029), families worrying about the high cost of medical care (P = 0.020), families consulted each other repeatedly (P = 0.022), and consulted the other medical staff (P = 0.022) are risk factors of DTST delay, and city residence (P = 0.048) is the protection factor of DTST delay. Conclusions The long time of DTS is a reality of the practice of primary PCI in China. The factors that lead to longer DTST include demographic characteristics, psychological factors and coping strategies of family members. The STBT of primary PCI in China should be taken into the value while emphasizing the DTBT.
作者
陈盼盼
董淑娟
李静超
余海佳
宋慧慧
杨亚攀
乔堃
龙东阳
谭远远
孔春灵
楚英杰
Chen Panpan;Dong Shujuan;Li Jingchao;Yu Haijia;Li Huihui;Yang Yapan;Qiao Kun;Long Dongyang;Tan Yuanyuan;Kong Chunling;Chu Yingjie(Department of Cardiology, People's Hospital of Zhengzhou University, Zhengzhou 450003, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2019年第5期596-603,共8页
Chinese Journal of Emergency Medicine
基金
河南省重点科技攻关计划项目(1221023100).
