急性主动脉夹层患者发病至到达首诊医院时间的调查研究

背景　急性主动脉夹层起病急、进展快，部分患者到达医院前就已经死亡。目前关于患者发病到入院时间的研究较少。目的　探索急性主动脉夹层患者发病至到达首诊医院时间的现状、影响因素，为缩短患者院前时间、及早到达医院提供理论支撑。方法　选取2018年3-11月武汉市某三级甲等医院心脏大血管外科收治的急性主动脉夹层患者，经过预调查采用自行设计的《急性主动脉夹层患者院前时间调查表》收集患者一般资料、疾病相关因素、院前相关因素，采用多元线性回归分析探讨急性主动脉夹层患者院前时间的影响因素。结果　共发放问卷200份，回收有效问卷173份，有效回收率为86.50%。173例患者院前时间为12~20 350 min，平均为〔70.0（36.5，150.0）〕min。 不同文化程度、月收入、居住情况、到达居住地最近医疗机构的时间、既往史（胃病）、吸烟情况、饮酒情况、症状（胸或背部痛、大汗、呼吸困难）、疼痛程度、持续性疼痛情况、以前有无类似症状、对疾病的了解程度、发病时间、发病时正在做什么、旁观者反应、自觉严重程度、入院方式、采取措施（打120，自己或让他人送去医院，呼叫或打电话寻求帮助，归因于其他疾病，尽量休息、放松，忍耐等待症状缓解，吃药）患者院前时间比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示，文化程度、到达居住地最近医疗机构的时间、持续性疼痛情况、旁观者的反应、自觉严重程度、入院方式为打车、归因于其他疾病为院前时间的影响因素（P<0.05）。结论　患者的文化程度越高、到达居住地最近医疗机构的时间越短、自觉症状越严重，院前时间越短；有持续性疼痛、发病时旁观者反应为采取就医措施、打120入院的患者院前时间较短；发病后归因于其他疾病的患者院前时间较长。需增强公众对急性主动脉夹层的认知和警觉意识，发病后采取积极的就医措施，推荐打120入院。

Time Interval from Onset to First Hospital Admission in Patients with Acute Aortic Dissection

Background Acute aortic dissection(AAD)is characterized by acute onset and rapid progress.Some patients die before reaching hospital.But available studies concerning time interval from onset of AAD to hospital admission are rare.Objective This study aimed to explore the time interval from onset of AAD to first hospital admission and associated factors in AAD patients,providing theoretical support for shortening prehospital time to timely obtain hospital care in such patients.Methods A total of 173 patients with AAD from department of cardiac macrovascular surgery of a grade A tertiary hospital,Wuhan were enrolled during March to November,2018.A self-developed questionnaire named Prehospital Time in Acute Aortic Dissection Patients was used to survey the patients to collect demographics,AAD-related factors and factors possibly associated with prehospital time.Multiple linear regression analysis was used to determine the factors associated with prehospital time.Results The survey obtained a response rate of 86.50%(173/200).The prehospital time in the 173 respondents was 12-20350 minutes〔averaged 70.0(36.5,150.0)〕minutes.The prehospital time varied significantly according to education level,monthly income,prevalence of independent living,time required to access to the nearest medical institution from home,history of past illness(i.e.gastric disease),smoking and drinking prevalence,onset symptoms(chest or back pain,profuse sweating,dyspnea),level of pain at onset,prevalence of persistent pain at onset,history of symptoms similar to onset symptoms,perceptions of AAD,onset time,what is being done at the onset time,bystander response,self-perceived severity of disease,means of admission(by dialing 120 to call an ambulance,going to the hospital by oneself or under the help of others,by calling for help,seeking hospital care due to other diseases),and prehospital interventions(try to rest or relax,bearing the suffering till symptom relief,medication)(P<0.05).Multiple linear regression analysis showed that education level,time required to access to the nearest medical institution from home,prevalence of persistent pain at onset,bystander response,self-perceived severity of disease,going to the hospital by taxi,and seeking hospital care due to other diseases were associated with the prehospital time(P<0.05).Conclusion Higher education level was associated with shorter time used to access to the nearest medical institution from home.Higher self-perceived severity of disease was associated with shorter prehospital time.Moreover,having persistent pain at the onset,positive response of the bystanders,and dialing 120 to call an ambulance were associated with shorter prehospital time.However,seeking hospital care due to other diseases was associated with longer prehospital time.In view of this,to shorten the prehospital time to timely obtain hospital care,public perceptions and vigilance consciousness of AAD need to be improved,active interventions should be taken after the onset,and dialing 120 to call an ambulance is recommended.