急性心肌梗死患者就医行为的现状分析

目的 了解急性心肌梗死患者就医行为及其对就医延误的影响.方法 采用自行设计的问卷调查表,对53例急诊行冠脉介入治疗(PCI)的急性心肌梗死(AMI)患者的就医行为、就诊时间及其对预后的影响进行了调查和分析.结果 (1)AMI患者院前延迟时间中位数为3.20h,≤2.00h者占30.19%,2.00h者占69.81%;就诊延迟时间中位数为4.00h,≤6.00h者占88.68%,6.00h者占11.32%.(2)发病后,症状归因于心脏病者占45.28%,归因于非心脏病者占43.40%,不知道者占11.32%,其院前延迟时间中位数分别为2.10h、3.20h和3.90h(P<0.01),就诊延迟时间中位数分别为3.50h、4.80h和5.90h(P<0.01);立即就诊者占32.08%,等待或自行治疗者占60.38%,向朋友家人家庭医生咨询者占7.54%,其院前延迟时间中位数分别为1.10h、3.50h和3.50h(P<0.01),就诊延迟时间中位数分别为3.00h、4.90h和6.00h(P<0.01);采用救护车转运者占54.72%,采用出租车、自家车等其他方式转运者占45.28%,其院前延迟时间中位数分别为2.20h和3.80h(P<0.01),就诊延迟时间中位数分别为3.70h和5.15 h(P<0.01);首诊于三级医院者占79.25%,首诊于二级医院者占11.32%,首诊于社区医院或诊所者占9.43%,其院前延迟时间中位数分别为2.55h、4.60h和4.00h(P<0.01),就诊延迟时间中位数分别为3.75 h、5.95 h和5.50h(P<0.01);立即选择PCI治疗者占66.04%,向朋友家人家庭医生咨询者占30.19%,等待或观察者占3.77%,其就诊延迟时间中位数分别为3.70h、11.00h和5.15h(P<0.01).(3)院前延迟时间≤2.00h者1年内心血管事件发生率明显低于2.00h者(0,27.03%,P<0.05).就诊延迟时间≤6.00h者1年内心血管事件发生率也明显低于6.00h者(14.89%,50.0%,P<0.05).结论 AMI患者目前仍存在不良就医行为,就医延误依然存在,且对预后产生不利影响,改善患者就医行为不容忽视.

The analysis on present situation of hospitalizing behaviors in patients with acute myocardial infarction

Objective To know about the hospitalizing behaviors of acute myocardial infarction (AMI) patients and the influence of that on delay to see doctor of patients. Methods The hospitalizing behaviors, time to see doctor and cardiovascular events of 53 AMI patients were investigated by questionary. Results The median time of prehospital delay in 53 patients with AMI was 3.20h. Meanwhile there were 16 patients(30.19%) whose median time of prehospital delay ≤ 2.00 h, and there were 37 patients(69.81%) whose median time of prehospital delay 2.00 h. The median time of treatment-seeking delay in 53 patients with AMI was 4.00 h. Meanwhere there were 47 patients (88.68%) whose median time of treatment-seeking delay ≤6.0Oh,and there were 6 patients (11.32%) whose median time of treatment-seeking delay 6.00 h. There were very significant difference on the time of prehospital delay and treatment-seeking delay among different hospitalizing behaviors in patients with AMI (P<0.01). The cardiovascular event incidence in the patients whose median time of prehospital delay ≤ 2.00h significant less than those whose median time of prehospital delay 2.00 h. (0 vs 27.03%, P < 0.05). The cardiovascular event incidence in the patients whose median time of treatment-seeking delay≤6.00h significant less than those whose median time of treatment-seeking delay 6.00 h. (14.89% vs 50.0% , P < 0.05). Conclusion AMI patient still has bad hospitalizing behaviors at present. Treatment-seeking delay still exists,and adversely affect prognosis.