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经济欠发达地区急诊PCI治疗急性ST段抬高型心肌梗死患者的D2B时间延误分析
作者:王万虹  张荣林  高千  冯毅  程勇 
单位:1. 南京大学医学院, 江苏 南京 210093;2. 南京鼓楼医院集团宿迁市人民医院 心内科, 江苏 宿迁 223800);3. 南京大学医学院附属鼓楼医院 心脏科, 江苏 南京 210008;4. 东南大学附属中大医院 心内科, 江苏 南京 210009
关键词:欠发达地区 急性心肌梗死 急诊PCI 门诊-次球囊扩张时间 延误 
分类号:R541.4
出版年·卷·期(页码):2012·31·第六期(739-741)
摘要:

目的:分析经济欠发达地区急性ST段抬高型心肌梗死(STEMI)患者门诊-首次球囊扩张(D2B)时间延迟原因, 为在我国大部分欠发达地区推广STEMI的规范化治疗提供依据。方法:共收集病例142例,其中欠发达地区组51例,发达地区组91例;根据D2B时间分为≤90 min组和>90 min组。分析年龄、性别、家庭经济状况、医疗保险状况、家属或本人受教育程度、高血压、高血脂、糖尿病、吸烟、胸痛症状、手术沟通签字时间等因素对D2B时间延误的影响。结果:(1)经多因素Logistic回归分析,年龄、经济状况、医疗保险状况、不典型胸痛、手术沟通签字时间与D2B时间延误独立相关(P<0.05)。(2)D2B时间南京鼓楼医院集团宿迁市人民医院明显长于中大医院(P<0.05),到达急诊室至确诊时间及签字后至D2B时间两所医院差异无统计学意义(P>0.05),前者手术沟通签字时间明显长于后者(P<0.05)。(3)经多因素Logistic回归分析,家庭经济状况、医疗保险状况、低教育程度与手术沟通签字时间显著延长有关,进而延误D2B时间。结论:手术沟通签字时间延长是导致D2B时间延误的重要因素,尤其是在经济欠发达地区,与家庭经济状况、医疗保险状况、陪护家属或本人教育程度密切相关。

Objective: To analyze door to balloon (D2B)time delay in primary percutaneous coronary intervention,and to provide evidence of the standardization for the treatment of acute myocardial infarction in underdeveloped area. Methods: A total of 142 cases were studied.Among them,51 cases were collected from underdeveloped area. According to whether the D2B time was within 90 minutes,these cases were divided into two groups.We determined the impact of age,gender,family economic status,health insurance,education level,hypertension,hyperlipidemia,diabetes,smoking,characteristics of chest pain,operation communication time or other factors on the D2B time delay. Results: (1)Multivariate Logistic regression revealed that age,economic status,health insurance status,characteristics of chest pain (atypical),operation communication time all independently were correlated with the D2B time delay(P<0.05).(2)Compared with Zhongda Hospital,D2B time was significantly longer in Suqian People's Hospital(P<0.05),while there was no difference in time of arriving,making diagnosis,signing and D2B(P>0.05). Operation communication time was significantly longer in Suqian People's Hospital (P<0.05). (3)By multivariate Logistic regression analysis,we found that family economic status,health insurance status,education level might effect operation communication time significantly. Conclusions: Operation communication time is longer in underdeveloped area,and it is main cause of D2B time delay. Family economic status,health insurance status and education level effect the former significantly.

参考文献:

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