辽宁省农村地区急性心肌梗死患者院前延迟时间影响因素研究

背景　农村地区急性心肌梗死（AMI）患者就医延迟现象不容乐观，目前相关研究略显不足。目的　探讨辽宁省农村地区AMI患者院前延迟时间特点及其影响因素，以期为提出有针对性的改善措施提供理论基础。方法　于2010年8月—2012年2月，采用便利抽样法选取辽宁省15家县级医院收治的AMI患者822例为研究对象。采用问卷调查的形式收集患者信息，调查内容包括性别、年龄、吸烟史、饮酒史、高血压史、高血脂史、糖尿病史、脑卒中史、心绞痛史、心肌梗死史、血管重建史、慢性病自我治疗情况、症状发生时间（发病季节、发病时间段）、出发前往医院时间、到达医院时间、医院的级别、患者转移情况、交通方式、迟疑就医的原因。采用有序Logistic回归模型分析院前延迟时间的影响因素。结果　农村AMI患者院前延迟时间为140（220）min。院前延迟时间的影响因素有糖尿病史〔OR=2.368，95%CI（1.501，3.734）〕、慢性病自我治疗情况〔治疗一种慢性病：OR=0.596，95%CI（0.398，0.894）〕、发病时间段〔6：00~11：59：OR=0.314，95%CI（0.193，0.511）；12：00~17：59：OR=0.458，95%CI（0.276，0.761）〕、出发前往医院时间〔6：00~11：59：OR=3.035，95%CI（1.876，4.908）；12：00~17：59：OR=2.189，95%CI（1.326，3.612）〕、患者转移情况〔间接转移且采取措施：OR=4.015，95%CI（2.176，7.407）；间接转移但未采取措施：OR=3.554，95%CI（1.793，7.044）〕、交通方式〔其他：OR=1.695，95%CI（1.004，2.861）〕、迟疑就医的原因〔路途遥远：OR=0.083，95%CI（0.058，0.119）；贫穷：OR=0.352，95%CI（0.161，0.770）；其他：OR=0.584，95%CI（0.393，0.868）〕（P<0.05）。结论　农村地区AMI患者院前延迟时间较长，可能原因是其对AMI认识不足、就诊意识薄弱以及卫生资源相对匮乏，建议加强农村地区急性疾病的宣传教育并制定措施以改善相对落后的医疗状况。

Factors Associated with Prehospital Delay among Patients with Acute Myocardial Infarction in Rural Areas of Liaoning Province

Background　Prehospital delays in acute myocardial infarction（AMI） patients in rural areas are common，but this issue has not been studied well in China.Objective　To investigate the characteristics and associated factors of prehospital delay in rural areas AMI patients in Liaoning province，providing theoretical evidences for delivering targeted interventions.Methods　From August 2010 to February 2012，we enrolled a total of 822 AMI inpatients who received treatment in 15 county-level hospitals of Liaoning province by convenience sampling and surveyed them with a self-developed questionnaire for collecting the following data：sex，age，history of smoking and drinking，medical history（hypertension，hyperlipidemia，diabetes mellitus，stroke，angina and myocardial infarction），history of revascularization treatment，self-treatment for chronic diseases，attack time of AMI（onset season，circadian rhythm），departure time for seeking treatment，arrival time at the hospital，hospital level，prehospital transfer，mode of transport and causes of delay in seeking treatment.Ordinal Logistic regression model was used to analyze the association between these aforementioned factors and prehospital delay.Results　Prehospital delay time in rural areas AMI patients was 140（220） min.In the analysis of ordinal Logistic model，history of diabetes mellitus〔OR=2.368，95%CI（1.501，3.734）〕 and self-treatment for chronic diseases〔OR=0.596，95%CI（0.398， 0.894）〕，circadian rhythm in AMI onset〔6：00-11：59：OR=0.314，95%CI（0.193，0.511）；12：00-17：59：OR=0.458，95%CI（0.276，0.761）〕，departure time for seeking treatment〔6：00-11：59：OR=3.035，95%CI（1.876，4.908）；12：00-17：59：OR=2.189，95%CI（1.326，3.612）〕，prehospital transfer〔indirect transfer with medical measures：OR=4.015，95%CI（2.176，7.407）； indirect transfer without medical measures：OR=3.554，95%CI（1.793，7.044）〕，the mode of transport except ambulance，taxi，vehicle，walking and manual handing〔OR=1.695，95%CI（1.004，2.861）〕，causes of delay in seeking treatment〔way far away：OR=0.083，95%CI（0.058，0.119）； poverty：OR=0.352，95%CI（0.161，0.770）；others：OR=0.584，95%CI（0.393，0.868）〕 were independent associated factors of prehospital delay（P<0.05）．Conclusion　The rural areas AMI patients in Liaoning province have long prehospital delay，which is associated with many factors，such as insufficient recognition of AMI，poor sense of seeking treatment，and relative lack of medical resources.In view of this，greater efforts should be made to publicize the knowledge about this disease and interventions should be taken to improve the poor medical status.