急性胸痛患者呼叫急救医疗服务延迟的影响因素分析

摘要

目的 分析急性胸痛患者从发作至呼叫急救医疗服务(EMS)的延迟状况及其影响因素.方法 连续入选北京地区2014-01~2015-12因胸痛呼叫EMS且送往北京大学人民医院救治的患者304例,搜集患者的基本人口学特征、救治时间点、病史特点、病因及预后,以患者发病至呼叫EMS的中位时间为切点分为呼叫无延迟组和呼叫延迟组,对比分析两组基线资料.结果 304例患者中,男性151例(占49.7%),中位年龄74岁,心源性疾病167例(占54.9%),其中急性冠状动脉综合征(ACS)85例(占28.0%),急诊病死率8.2%、急诊入院率25.3%、总体死亡率9.5%.院前时间、患者时间和转运时间分别为180 min、96 min和63 min.多因素研究发现,年龄≥65岁的老年人、城区呼叫、胸痛部位典型和伴有发热与患者从发病至呼叫EMS的时间延迟有关.结论 急性胸痛患者的院前救治,尤其应关注老年人、郊区居民和冠心病患者,建议尽早呼叫EMS来院,以缩短院前时间.%Objective To describe status on the duration from onset to calling EMS in patients with acute chest pain and to analyze influence factors on delay in calling EMS.Methods Successive 304 patients with acute chest pain, who called EMS in Beijing area and were transported to Peking University People's Hospital, were included.Data on basic demographic characteristics, treatment time points, medical history, causes and outcomes were collected.The patients were categorized into two groups based on the median duration from onset to calling, and their baseline information was compared.Results Of those 304 cases with chest pain, 151 cases(49.7%)were male, and the median age was 74 years.The chest pain causes of 167 cases(54.9%)were cardiac origin, and 85 cases(28.0%)were acute coronary syndrome.Mortality at emergency department was 8.2%, emergency admission rate was 25.3%, while overall mortality was 9.5%.Pre-hospital time, patient time and EMS transport time were 180 min, 96 min and 63 min respectively.Multivariate Logistic analysis showed that the aged more than 65 years old, calling from urban area, precordial or retrosternal pain and accompanied with fever were associated with delay in calling EMS independently.Conclusion Patients with acute chest pain, especially the aged, suburban residents and patients with coronary heart disease, should be advised to call EMS as soon as possible in order to reduce pre-hospital time.