脑卒中高危者院前延迟行为意向现状及影响因素分析

目的调查脑卒中高危者院前延迟行为意向的现状并分析其影响因素。方法采用一般资料问卷、脑卒中患者院前延迟行为意向测评量表,对哈尔滨市某三级甲等医院和哈尔滨市3所社区卫生服务中心的脑卒中高危者320例进行调查。结果脑卒中高危者的院前延迟行为意向测评量表总分及各维度的平均得分率均大于50.00%。家庭人均月收入、体检状况、是否接受培训或自学脑卒中知识是脑卒中高危者院前延迟行为意向的影响因素。结论脑卒中高危者院前延迟行为意向水平较高,提示医务人员和有关健康教育工作者需要重视脑卒中高危者对症状的习惯反应,加强急救系统使用、定期体检的健康教育,并提供脑卒中知识教育,从而有效减少脑卒中院前延迟的发生。     

糖尿病和非糖尿病首次急性心肌梗死者院前延迟行为研究

目的探讨糖尿病和非糖尿病首次急性心肌梗死者院前延迟行为现状及影响因素。方法采用院前延迟行为意向测评量表对96例首次急性心肌梗死者进行调查,将其分为糖尿病组(n=41)与非糖尿病组(n=55)。比较两组院前延迟时间、院前延迟行为意向及影响因素。结果糖尿病组院前延迟时间为(1.73±0.58)h、院前延迟行为评分为(50.16±14.07)分,非糖尿病组分别为(2.87±0.61)h、(58.93±13.24)分,糖尿病组短于非糖尿病组,组间比较差异有统计学意义(P0.05);糖尿病组患者症状觉察、习惯性行为、症状程度判断评分明显高于非糖尿病组,组间比较差异有统计学意义(P0.05);糖尿病急性心梗患者MACE发生率为27.27%,非糖尿病患者发生率为55.77%,差异有统计学意义(P0.05);体检情况与院前延误时间2 h以上有关(r=-0.155,P0.05)。结论糖尿病合并急性心肌梗死患者院前延误时间明显短于非糖尿病患者,症状觉察更敏锐、症状程度判断较准确可能是其主要原因。     

急诊缺血性脑卒中患者溶栓就医延迟风险因素分析

目的探讨急诊缺血性脑卒中(AIS)患者溶栓就医延迟的风险因素,为促进AIS患者溶栓早日就诊提供科学指导。方法选取2018年5月—2019年12月医院急诊科就诊的AIS患者147例为研究对象,其中51例发生院前延迟的患者为院前延迟组(病例组),96例正常入院的患者为正常入院组(对照组)。采用单因素分析和多因素Logistic回归分析影响其溶栓就医延迟的相关因素。结果单因素分析显示,年龄、心脏病史、GCS评分、居住方式、NIHSS评分、疾病知识相关宣教、焦虑或抑郁评分、医护人员防治意识是AIS患者溶栓就医延迟的相关因素(P<0.05)。多因素Logistic回归分析显示,高龄、心脏病史、疾病知识相关宣教、焦虑或抑郁评分、医护人员防治意识欠缺是影响AIS患者溶栓就医延迟的独立危险因素(P<0.05)。结论 AIS患者溶栓就医延迟现况普遍存在,强化高龄、心脏病史患者健康知识宣教,改善心理状态,提升医护人员防患意识,是减少就医延迟风险及改善生活质量的关键。     

分级预警联合三维护理模式在急性胸痛患者院前-院内急救衔接中的应用

目的:探讨分级预警联合三维护理模式在急性胸痛患者院前-院内急救衔接中的应用效果。方法:将2017年5月1日~2018年12月31日收治的2075例急性胸痛患者运用常规急救交接模式(实施前),将2019年1月1日~2020年10月1日收治的2123例急性胸痛患者运用分级预警联合三维护理模式(实施后);比较实施前后各节点抢救时间、抢救效果、预后情况及患者满意度评分。结果:实施后院前-院内交接时间、护理评估完成时间、心电图完成时间、标本采集完成时间、确定诊断时间、急诊室停留时间及首次接受治疗时间均短于实施前(P<0.01);实施后需急诊PCI术、30 d病死率、心力衰竭、心源性休克、恶性心律失常及不良心血管事件(MACE)总发生率均低于实施前(P<0.01);实施后抢救成功率、护理操作技能、急救知识掌握、反应能力、医护配合及总满意度评分均高于实施前(P<0.01)。结论:将分级预警联合三维护理模式应用于急性胸痛患者院前-院内急救衔接中,不仅能缩短抢救时间,提升抢救成功率,还能减少MACE发生,从而改善预后和提高患者满意度。     

急性缺血性脑卒中患者院前延迟影响因素的Meta分析

目的探讨急性缺血性脑卒中患者院前延迟的影响因素,为预防决策提供依据。方法以"缺血性脑卒中"、"院前延迟"、"就诊延迟"、"stroke"、"prehospital delay"、"pre-hospital delay"为检索词,收集2004年至2015年关于急性缺血性脑卒中院前延迟影响因素的文献,按照纳入与剔除标准选择文献,评价质量,提取数据,采用RevMan软件进行Meta分析。结果共纳入文献16篇,累计延迟组2966例,非延迟组2468例。影响急性缺血性脑卒中院前延迟多因素的OR及95%CI分别为:卒中重视度0.5(0.30,0.82)、急救医疗服务(emergency medical service,EMS)0.49(0.29,0.85)、国立卫生研究院卒中量表(National Institute of Health Stroke scale,NHISS)评分0.58(0.36,0.95)、首诊门诊4.28(1.44,12.74)、距离0.76(0.61,0.95)、缺血性脑卒中病史0.37(0.18,0.79),均P0.05,差异具有统计学意义。结论急性缺血性脑卒中患者院前延迟保护因素为卒中重视度高、采用EMS、NHISS评分高、距离近、有缺血性脑卒中病史;危险因素为首诊门诊。这提示我们应加强脑卒中患者急救意识,加强患者及家属相关知识教育,增加急救系统使用率,建立完善、高效的缺血性脑卒中的绿色通道,缩短急性缺血性脑卒中患者延迟就诊。     

肠造口患者个人掌控感对其自我照护行为执行意向的影响

目的探讨肠造口患者个人掌控感对自我照护行为执行意向的影响。方法 2021年3-6月,采用便利抽样法选取在青岛市某三级甲等医院造口门诊就诊的182例肠造口患者作为研究对象,采用一般资料调查表、个人掌控感量表、领悟社会支持量表、肠造口患者自我照护行为执行意向问卷对其进行调查。结果肠造口患者自我照护行为执行意向得分为(76.24±16.83)分、个人掌控感得分为(20.68±2.47)分;多因素分析显示,家庭人均月收入、造口术后时间、个人掌控感、领悟社会支持为肠造口患者自我照护行为执行意向的主要影响因素(均P0.05),共解释总变异量的43.5%。结论肠造口患者自我照护行为执行意向处于中等偏低水平,医护人员应多关注家庭人均月收入较低、造口术后时间短的肠造口患者,可通过提高其个人掌控感、社会支持水平,从而促进自我照护行为执行意向的形成。     

80例接受辅助生殖技术治疗的高龄女性心理状态调查及其影响因素分析

目的 探讨接受辅助生殖技术(ART)治疗的高龄女性心理状态及其影响因素。方法 选取2017年10月～2019年10月我院接受ART治疗的80例高龄女性。统计女性心理障碍发生情况,收集所有女性的基线资料,经单因素与多因素分析接受ART治疗的高龄女性并发心理障碍的影响因素。结果 80例接受ART治疗的高龄女性中并发心理障碍者15例,占比18.75%。经单项Logistic回归分析后建立多元回归模型,结果显示,受教育程度、不孕年限、家庭人均月收入、家人支持情况、夫妻关系是引起心理障碍的影响因素(OR1,P0.05)。结论 受教育程度低、不孕年限长、家庭人均月收入低、家人不支持、夫妻关系不和谐是引起接受ART治疗的高龄女性发生心理障碍的影响因素。     

儿科急诊高热惊厥患儿就医行为与家庭动力学的相关性及影响因素研究

目的 探究儿科急诊高热惊厥患儿就医行为与家庭动力学的相关性及影响因素。方法 采用便利抽样法选择医院急诊科2020年6月—2022年5月收治的150例高热惊厥患儿家属为研究对象,使用一般资料问卷调查患儿及家属的相关信息,采用患儿父母就医行为量表、系统家庭动力学自评问卷面向患儿家属开展调查。结果 结果显示,患儿家属的就医行为问卷总分为(30.49±12.52)分,就医行为差的患儿共31例(20.67%);系统家庭动力学自评问卷总分为(108.40±18.08)分;Pearson相关性分析结果显示,儿科急诊高热惊厥患儿就医行为问卷总分、维度评分与家庭动力自问卷总分、维度评分呈负相关(r=-0.332～-0.168,P<0.05);多因素logistic回归分析结果显示,儿科急诊高热惊厥患儿就医行为独立影响因素包括患儿是否独生子女、患儿近期发热有无症状、患儿居住地、患儿家属与患儿关系、患儿家属学历、周围有无相关病例、家属是否接受相关宣教、患儿家属是否具有急救素养、患儿家属家庭动力水平(P<0.05)。结论 不同特征的儿科急诊高热惊厥患儿就医行为表现存在差异,患儿就医行为与家庭动力学...     

预见性护理在创伤患者急诊院前院内一体化救治中的应用效果

目的 探究预见性护理在创伤患者急诊院前院内一体化救治中的应用效果。方法 我院 2021 年 5 月到 2022 年 4 月收治的 60 例急诊创伤患者，依循单双数法分为对照组和观察组，每组各 30 例。对照组急诊院前院内一体化救治期间实施常规性护理， 观察组急诊院前院内一体化救治期间实施预见性护理。比较两组的急救时间、急救效果与护理满意度。结果 观察组休克缓解、 病情评估、辅助检查、急诊会诊、术前准备、有效救治时间均短于对照组（P<0.05）。观察组急救有效率（100.00％）高于对照 组（86.67％）（P<0.05）。观察组护理满意度大于对照组（P<0.05）。结论 创伤患者的急诊院前院内一体化救治中应用预见性护 理，可缩短急救时间，提高急救效果和满意度。     

急性ST段抬高型心肌梗死患者院前延迟影响因素分析

目的分析急性ST段抬高型心肌梗死(STEMI)患者院前延迟影响因素,为降低急性心肌梗死患者院前延迟时间提供理论依据。方法连续收集我院2014年1月-2015年12月行急诊PCI治疗的ST段抬高型急性心肌梗死患者267例为研究对象,以调查问卷及查阅病历资料形式收集患者的一般资料、冠心病相关危险因素、心肌梗死相关症状等具体因素,从而分析出可能影响患者及时就诊的相关因素。结果根据院前延迟时间分为痛门时间≤2h组(108例)、2h痛门时间6h组(117例)、痛门时间≥6h三组(42例),院前延迟时间与年龄、糖尿病病史、家庭人均收入、既往心绞痛病史、突然起病、重症症状/典型症状及把症状归因于心脏病等相关(P0.05)。结论应加强心血管疾病的普及、宣传力度,能够让患者深刻认识到心脏疾病的起病特点、临床表现、高危害性和早期及时诊治的重要性,尤其对高龄、患有糖尿病、低收入家庭及既往存在心绞痛病史者。     

Physician Variability in History Taking When Evaluating Patients Presenting with Chest Pain in the Emergency Department

Objectives: The goal of this study was to examine how physicians in the emergency department ask questions of patients presenting with chest pain and whether this varies by patient demographics.
Methods: This was a cross-sectional study with convenience sampling. A survey was administered to adult emergency department patients presenting with chest pain after emergency physicians obtained the history and performed the physical examination. No identifying data were collected from the patients. In addition to demographics, patients were asked whether or not their physician asked them about factors related to coronary syndrome and myocardial infarction etiology.
Results: A total of 308 of 332 patients (93%) participated. Patients had a mean age of 52 years, 54% were male, and 85% spoke English; classification by race was 31% African American, 28% white, 19% Hispanic, and 13% other. History taking did not differ by gender. Patients who reported being asked about the following were statistically significantly younger than those who reported not being asked: family history, other medical problems, smoking, cocaine use, and alcohol use. Nonwhite patients reported being asked about the following more frequently than white patients: smoking (94% vs. 84%), alcohol use (81% vs. 70%), and cocaine use (64% vs. 42%). In multivariate logistic regression controlling for age, nonwhite patients were more likely than white patients to be asked about smoking (odds ratio [OR], 2.79; 95% confidence interval [CI] = 1.26 to 6.19), cocaine use (OR, 2.49; 95% CI = 1.50 to 4.12), and alcohol use (OR, 1.77; 95% CI = 1.0 to 3.09).
Conclusions: The variability in questions about behavioral factors associated with chest pain etiology as reported by patients may indicate a possible cultural bias by physicians. Differences in risk identification may lead to differences in treatment decisions.     

36例突发致命性胸痛病人院前急救和转运效果分析

目的探讨突发致命性胸痛病人院前急救及转运效果。方法回顾性分析深圳市急救中心院前急救科2006年1月至2009年1月接收的突发致命性胸痛病人36例的临床资料,并比较同期自行人院的21例同类病人病死率。结果院前急救组病人经专业现场急救处理后,其处理前后呼吸、心率、血压、胸痛程度差异均有统计学意义,院前急救组病死率低于自行入院组。结论突发致命性胸痛病人临床表现复杂,专业的院前急救能及时抢救监护,合理用药,保证安全、快速、有效转送,病情控制较好,有效降低病死率。     

Thallium myocardial scanning in the emergency department evaluation of chest pain

Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a "classic" history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.     

急性胸痛患者使用院前急救医疗服务的影响因素探讨

目的分析急性胸痛患者的基本特征,探讨其选择使用院前急救医疗服务（EMS）的影响因素。方法连续收集2014年10月至2015年4月所有因急性胸痛就诊山东大学齐鲁医院急诊科的747例有效患者。记录急性胸痛患者的人口学特征、就诊方式、胸痛特点、既往史。采用Logistic 多因素回归分析比较急性胸痛患者的年龄、性别、文化程度、医保类型、胸痛症状是否典型、有无放射痛及既往病史是否与使用 EMS 有关。结果747例急性胸痛患者中男性414例,占55.4％,年龄（57.2±15.8）岁,女性333例,占44.6％,年龄（61.7±14.9）岁,使用 EMS 共171例,占22.9％;未使用 EMS 576例,占77.1％。年龄大于75岁胸痛患者134例,较其他年龄段胸痛患者更倾向于使用 EMS （P ＜0.01）,65～75岁年龄组胸痛患者152例,使用 EMS 比例最低;男性比女性更倾向于使用 EMS （P ＜0.05）;典型胸痛患者483例,使用 EMS 比例较胸痛不典型患者高（P ＜0.05）;既往有高血压病史胸痛患者356例,脑梗死病史胸痛患者54例,使用 EMS的比例较高（均 P ＜0.01）。多因素 Logistic 回归分析显示：男性、年龄大于75岁、既往脑梗死病史是急性胸痛患者 EMS 使用的独立影响因素（P ＜0.05）。结论本研究胸痛患者中使用 EMS 的比例低于1／3。男性、年龄大于75岁、脑梗死病史的急性胸痛患者更倾向于使用 EMS。对于未使用EMS 的急性胸痛患者应加强宣教,以促进患者求医行为的增强,改善预后。     

Diagnostic Accuracy of History and Physical Examination for Predicting Major Adverse Cardiac Events Within 30 Days in Patients With Acute Chest Pain

BackgroundThe cornerstones in the assessment of emergency department (ED) patients with suspected acute coronary syndrome (ACS) are patient history and physical examination, electrocardiogram, and cardiac troponins. Although there are several prior studies on this subject, they have in some cases produced inconsistent results.ObjectiveThe aim of this study was to evaluate the diagnostic and prognostic accuracy of elements of patient history and the physical examination in ED chest pain patients for predicting major adverse cardiac events (MACE) within 30 days. Methods: This was a prospective observational study that included 1167 ED patients with nontraumatic chest pain. We collected clinical data during the initial ED assessment of the patients. Our primary outcome was 30-day MACE.ResultsPain radiating to both arms increased the probability of 30-day MACE (positive likelihood ratio [LR+] 2.7), whereas episodic chest pain lasting seconds (LR+ 0.0) and >24 h (LR+ 0.1) markedly decreased the risk. In the physical examination, pulmonary rales (LR+ 3.0) increased the risk of 30-day MACE, while pain reproduced by palpation (LR+ 0.3) decreased the risk. Among cardiac risk factors, a history of diabetes (LR+ 3.0) and peripheral arterial disease (LR+ 2.7) were the most predictive factors.ConclusionsNo clinical findings reliably ruled in 30-day MACE, whereas episodic chest pain lasting seconds and pain lasting more than 24 h markedly decreased the risk of 30-day MACE. Consequently, these two findings can be adjuncts in ruling out 30-day MACE.     

晚期肺癌病人癌性疼痛管理障碍现状及其影响因素分析

目的:探讨晚期肺癌病人癌性疼痛(CP)管理障碍现状及其影响因素。方法:回顾性分析2019年1月—2021年7月就诊于医院的98例晚期肺癌病人临床资料,分析晚期肺癌病人CP管理障碍现状及其影响因素。结果:晚期肺癌病人癌性疼痛控制障碍问卷(BQ)评分为(3.22±0.25)分;单因素分析显示:家庭人均月收入、文化程度、医疗付费方式、接受过疼痛管理相关培训、疾病不确定感高、慢性疼痛自我效能、应对方式与晚期肺癌病人CP管理障碍有关(P<0.05);多因素分析显示:家庭人均月收入<4000元、文化程度低、自费付费方式、未接受过疼痛管理相关培训、疾病不确定感高、慢性疼痛自我效能低、消极应对方式是影响晚期肺癌病人CP管理障碍的高危因素(P<0.05)。结论:晚期肺癌病人CP管理障碍处于较高水平,其与家庭人均月收入、文化程度、医疗付费方式、接受过疼痛管理相关培训、疾病不确定感、慢性疼痛自我效能、应对方式有关。     

Evaluation of chest pain in the ED: factors affecting triage decisions

The emergency physician's (EP) fast and correct diagnosis of patients with chest pain is crucial for preventing inappropriate discharge and dire consequences. To determine which factors affect admission decisions in the ED, we studied epidemiologic characteristics of both discharged and admitted patients, and the percentage of discharged patients who returned to the ED with acute myocardial infarction. The study included 185 patients seen in the ED because of chest pain between July 1 and 31, 1997 (every third day not included). Ninety patients were admitted: 36.7% were admitted for "observation of chest pain" and 63.3% met the criteria for active coronary heart disease. A form was used to collect personal data, medical history, risk factors, clinical examination, electrocardiogram interpretation, laboratory data, and admittance decision. EPs' diagnosis of cardiac chest pain demonstrated a sensitivity of 93.4%, a specificity of 73.4%, and a positive predictive value of 63.3%. Sensitivity for diagnosing acute myocardial infarct was 100%, with no erroneous discharges. The EP's ability to integrate the medical history information, including risk factors and pain characteristics, had a marked influence on the admittance decision. Efforts to reduce missed diagnoses are warranted.     

Analysis of factors affecting emergency physicians' decisions in the management of chest pain patients.

OBJECTIVE: The aim of this study was to determine the factors most affecting emergency physicians' decisions in the management of chest pain patients. METHODS: This prospective randomized cross-sectional study was carried out between March 2004 and September 2004 in an urban university hospital emergency department. Residents collected data on patients' demographic features, chest pain characteristics, electrocardiography, cardiac enzymes and outcome of patients. RESULTS: Five hundred and sixty-two patients were enrolled in the study; 389 (69.2%) patients were classified as having cardiac chest pain. Of the 389 patients suggested to have cardiac chest pain, 369 (94.4%) were classified as probable acute coronary syndrome; 286 (50.9%) patients were seen by cardiologists and 187 (33.3%) were admitted to the cardiology ward. The logistic regression analysis revealed that angina equivalents (P<0.001), age (P=0.002), history of coronary artery disease (P=0.003), electrocardiography (P=0.001), substernal chest pain (P=0.001), typical chest pain (P=0.000) and radiation of chest pain (P=0.039) were independent factors affecting emergency physicians' decisions. CONCLUSION: The factors affecting emergency physicians' decisions are correlated with guidelines.