Systematic evaluation and control measures of factors influencing prehospital delay in patients with acute myocardial infarction
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摘要: 目的 探讨急性心肌梗死患者院前延迟的影响因素,并明确应对策略,旨在缩短院前延迟时间。 方法 经Pubmed、Embase等十大数据库检索相关文献,用NOS量表评价纳入文献19篇,均为流行病调查研究,以Rev Man 5.3软件进行统计分析。 结果 通过Meta分析将影响因素归纳为3大类。①社会因素:年龄[OR=1.090,95%CI(1.060~1.130),P<0.001]、性别[OR=1.180,95%CI(1.050~1.330),P=0.006]、文化水平[OR=1.410,95%CI(1.190~1.670),P<0.001]、居住地区[OR=1.350,95%CI(0.990~1.840),P=0.060];②临床因素:糖尿病史[OR=1.380,95%CI(1.220~1.560),P<0.001]、心绞痛史[OR=1.370,95%CI=1.050~1.770,P=0.020]、心肌梗死史[OR=1.080,95%CI(0.640~1.830),P=0.760]、PCI史[OR=0.760,95%CI(0.670~0.860),P<0.001];③其他因素: 夜间发病[OR=1.630,95%CI(1.340~1.970),P<0.001]、就诊方式[OR=0.640,95%CI(0.570~0.710),P<0.001]、未将症状归因于心脏[OR=3.100,95%CI(1.620~5.940),P<0.001]。 结论 高龄、女性、糖尿病史、心绞痛史、夜间发病、未将症状归因于心脏是其危险因素,高学历、PCI史、EMS就诊是其保护因素,居住地区、心肌梗死史与急性心肌梗死患者院前延迟无关。采取切实有效地干预措施,能够缩短院前延迟时间,降低患者院外死亡率。Abstract: Objective To explore the influencing factors of prehospital delay in patients with acute myocardial infarction, and to identify strategies to reduce pre-hospital delay. Methods The relevant literature was searched by the top ten databases such as Pubmed and Embase, and the 19 articles included in the NOS scale were used only for epidemiological investigation and statistical analysis by RevMan 5.3 software. Results The meta-analysis was used to classify the influencing factors into three categories. ①Social factors:age [OR=1.090, 95% CI (1.060-1.130), P<0.001], gender [OR=1.180, 95% CI (1.050-1.330), P=0.006], cultural level [OR=1.410,95%CI(1.190-1.670),P<0.001], residential area [OR=1.350, 95% CI (0.990-1.840), P=0.060]; ②Clinical factors: history of diabetes [OR=1.380, 95% CI (1.220-1.560), P<0.001], history of angina [OR=1.370, 95 %CI=1.050-1.770, P=0.020], history of myocardial infarction [OR=1.080, 95% CI (0.640-1.830), P=0.760], PCI history [OR=0.760, 95% CI (0.670-0.860), P<0.001]; ③Other factors: nocturnal onset [OR=1.630, 95% CI (1.340-1.970), P<0.001], treatment mode [OR=0.640, 95% CI (0.570-0.710), P<0.001] The symptoms were not attributed to the heart [OR=3.100, 95% CI (1.620-5.94), P<0.001 ]. Conclusion Age, female, history of diabetes, history of angina pectoralis, nocturnal morbidity, failure to attribute symptoms to the heart are risk factors. High academic background, PCI history, EMS visit are protective factors. The residential area, history of myocardial infarction and the previous delay of acute myocardial infarction patients are irrelevant. Effective and effective interventions can reduce pre-hospital delays and decrease out-of-hospital mortality.
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Key words:
- Myocardial infarction /
- Prehospital delay /
- Influencing factors /
- Systematic evaluation
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