急性胸痛患者使用院前急救医疗服务的影响因素探讨

发布时间：2017-12-28 09:37

本文关键词：急性胸痛患者使用院前急救医疗服务的影响因素探讨　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析急性胸痛患者的基本特征,探讨其选择使用院前急救医疗服务的影响因素。方法连续收集2014年10月至2015年4月所有因急性胸痛就诊山东大学齐鲁医院急诊科的747例有效患者。记录急性胸痛患者的人口学特征、就诊方式、胸痛特点、既往史。采用Logistic多因素回归分析比较急性胸痛患者的年龄、性别、文化程度、医保类型、胸痛症状是否典型、有无放射痛及既往病史是否与使用EMS有关。结果747例急性胸痛患者中男性414例,占55.4%,年龄(57.2± 15.8),女性333 例,占 44.6%,年龄(61.7±14.9),使用 EMS 共 171 例,占 22.9%;非 EMS576例,占77.1%。急性胸痛患者中心血管系统疾病占大多数,以冠心病为主,其中以STEMI患者使用EMS最高,达50%,而NSTEMI,SCAD,UA使用EMS均不足30%。病因不明胸痛189例,使用EMS 24例,占12.7%。患者年龄65岁以下的患者共461例,使用EMS 98例,占21.3%,年龄在65-75岁的患者共152例,使用EMS 26例,占17.1%,年龄大于75岁的患者共134例,使用EMS 47例,占35.1%,年龄大于75岁胸痛相较65岁以下及65-75岁之间的胸痛患者更倾向于使用EMS(P0.001),而65-75岁年龄段胸痛患者使用EMS比例最低;典型胸痛患者483例,使用EMS比例较胸痛不典型患者高(P0.05);既往有高血压病史胸痛患者356例、脑梗塞病史胸痛患者54例,使用EMS的比例较高(P0.01;P0.001)。多因素Logistic回归分析显示:男性、年龄大于75岁、既往脑梗塞病史是急性胸痛患者EMS使用的独立影响因素(P0.05)。急性胸痛患者死亡23例,死亡率3.1%,其中心血管系统疾病死亡17例,占73.9%,病因不明疾病死亡5例,占 21.7%。结论本研究急性胸痛患者中使用EMS的比例低于1/3。男性、年龄大于75岁、脑梗塞病史的急性胸痛患者更倾向于使用EMS。急性胸痛病因构成以心血管系统和不明原因胸痛为主,这两类患者使用EMS比例不高,但死亡率高,应加强对这部分重点人群使用院前EMS的宣传教育,以促进患者求医行为的增强,改善预后。
[Abstract]:Objective to analyze the basic characteristics of patients with acute chest pain and to explore the factors affecting the use of pre hospital emergency medical service. Methods 747 patients with acute chest pain from October 2014 to April 2015 were collected from the emergency department of Qilu Hospital of Shandong University. The demographic characteristics, medical treatment, chest pain and past history of patients with acute chest pain were recorded. Multivariate Logistic regression analysis was used to compare the age, sex, education level, medical insurance type, chest pain symptoms, radiation pain and past medical history in patients with acute chest pain. It is related to the use of EMS. Results among 747 patients with acute chest pain, 414 were males, accounting for 55.4%, age (57.2 + 15.8), 333 women, 44.6%, age (61.7 + 14.9), 171 cases were used EMS, 22.9% cases, and non EMS576 cases accounted for 22.9%. The central vascular system diseases account for the majority of the patients with acute chest pain. Coronary heart disease is the main reason. Among them, EMS is the highest in STEMI patients, up to 50%, while EMS in NSTEMI, SCAD and UA is less than 30%. 189 cases of unknown etiology of chest pain, 24 cases of EMS were used, accounting for 12.7%. Patients under the age of 65 with a total of 461 cases, EMS 98 cases, accounting for 21.3%, at the age of 65-75 patients in 152 cases, EMS 26 cases, accounting for 17.1%, a total of 134 cases of patients with more than 75 year old age, the use of EMS in 47 cases, accounting for 35.1%, older than 75 years compared to patients with chest pain, chest pain. 65 years old and 65-75 years old are more likely to use EMS (P0.001), while the patients aged 65-75 with EMS the lowest proportion of chest pain; 483 patients with typical chest pain patients using EMS proportion is not typical chest pain patients (P0.05); 356 cases had a history of hypertension, chest pain in 54 patients with cerebral infarction in patients with chest pain. Use the higher proportion of EMS (P0.01; P0.001). Multiple factor Logistic regression analysis showed that male, older than 75 years old and previous history of cerebral infarction were independent factors (P0.05) for the use of EMS in patients with acute chest pain. Acute chest pain died in 23 cases, the mortality rate was 3.1%, of which 17 cases of cardiovascular disease died, accounting for 73.9%, and 5 cases of unidentified disease, accounting for 21.7%. Conclusion the proportion of EMS in patients with acute chest pain is lower than that of 1/3. Men, older than 75 years of age, and acute chest pain with a history of cerebral infarction are more likely to use EMS. The etiology of acute chest pain is mainly composed of cardiovascular system and chest pain with unknown causes. The proportion of EMS in these two kinds of patients is not high, but the mortality is high. Therefore, we should strengthen propaganda and education for pre hospital EMS in this group of patients, so as to enhance patient's behavior and improve prognosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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