CAJ | 학술논문

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.
목적 료해급성심기경사환자취의행위급기대취의연오적영향.방법 채용자행설계적문권조사표,대53례급진행관맥개입치료(PCI)적급성심기경사(AMI)환자적취의행위、취진시간급기대예후적영향진행료조사화분석.결과 (1)AMI환자원전연지시간중위수위3.20h,≤2.00h자점30.19%,2.00h자점69.81%;취진연지시간중위수위4.00h,≤6.00h자점88.68%,6.00h자점11.32%.(2)발병후,증상귀인우심장병자점45.28%,귀인우비심장병자점43.40%,불지도자점11.32%,기원전연지시간중위수분별위2.10h、3.20h화3.90h(P<0.01),취진연지시간중위수분별위3.50h、4.80h화5.90h(P<0.01);립즉취진자점32.08%,등대혹자행치료자점60.38%,향붕우가인가정의생자순자점7.54%,기원전연지시간중위수분별위1.10h、3.50h화3.50h(P<0.01),취진연지시간중위수분별위3.00h、4.90h화6.00h(P<0.01);채용구호차전운자점54.72%,채용출조차、자가차등기타방식전운자점45.28%,기원전연지시간중위수분별위2.20h화3.80h(P<0.01),취진연지시간중위수분별위3.70h화5.15 h(P<0.01);수진우삼급의원자점79.25%,수진우이급의원자점11.32%,수진우사구의원혹진소자점9.43%,기원전연지시간중위수분별위2.55h、4.60h화4.00h(P<0.01),취진연지시간중위수분별위3.75 h、5.95 h화5.50h(P<0.01);립즉선택PCI치료자점66.04%,향붕우가인가정의생자순자점30.19%,등대혹관찰자점3.77%,기취진연지시간중위수분별위3.70h、11.00h화5.15h(P<0.01).(3)원전연지시간≤2.00h자1년내심혈관사건발생솔명현저우2.00h자(0,27.03%,P<0.05).취진연지시간≤6.00h자1년내심혈관사건발생솔야명현저우6.00h자(14.89%,50.0%,P<0.05).결론 AMI환자목전잉존재불량취의행위,취의연오의연존재,차대예후산생불리영향,개선환자취의행위불용홀시.
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.