性别对ST段抬高型心肌梗塞患者院前延迟时间的影响

doi:10.3877/cma.j.issn.1674-6880.2016.06.004

中华危重症医学杂志(电子版) ›› 2016, Vol. 09 ›› Issue (06) : 376 -379. doi: 10.3877/cma.j.issn.1674-6880.2016.06.004

所属专题：文献；

论著

性别对ST段抬高型心肌梗塞患者院前延迟时间的影响

董永伟¹, 陈宇², 郑文¹, 贺晓楠¹^,^†(

)

^1. 100029　北京，首都医科大学附属安贞医院急诊危重症中心
^2. 130021　吉林长春，吉林大学中日联谊医院心内科

收稿日期:2016-01-22 出版日期:2016-12-01
通信作者: 贺晓楠
基金资助:
首都临床特色应用研究专项课题基金项目(Z141107002514014)

Effect of sex factor on pre-hospital system delay in patients with ST-segment elevation myocardial infarction

Yongwei Dong¹, Yu Chen², Wen Zheng¹, Xiaonan He¹^,^†()

^1. Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
^2. Department of Cardiology, China-Japan United Hospital Affiliated Jilin University, Changchun 130021, China

Received:2016-01-22 Published:2016-12-01
Corresponding author: Xiaonan He
About author:
Corresponding Author: He Xiaonan, Email: linda197861@126.com

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目的

探讨性别对ST段抬高型心肌梗塞（STEMI）患者院前延迟时间（PHDT）的影响。

方法

选择2014年4月至2015年11月明确诊断为STEMI并接受直接经皮冠状动脉介入治疗的患者447例。根据性别分成男性患者组（371例）及女性患者组（76例），比较两组患者间年龄、糖尿病、高血压、高脂血症、吸烟、冠心病、脑血管疾病、就诊方式、PHDT及医疗保险类型的差异，同时，将PHDT分为5段：0~3 h、> 3~6 h、> 6~12 h，> 12~24 h和> 24 h，建立多元Logistic回归模型评价性别及其他危险因素对不同PHDT的影响。

结果

女性患者的年龄显著高于男性患者的年龄[（64 ± 8）岁vs.（56 ± 11）岁，t = 1.040，P = 0.001]，且女性患者PHDT亦明显高于男性患者[（396 ± 38）min vs.（367 ± 30）min，t = 1.219，P = 0.017]。两组患者医疗保险的比较，差异有统计学意义（χ² = 5.500，P = 0.007）。多元Logistic回归模型分析显示，性别与院前时间延长有关（95%可信区间：0.216~0.981，P = 0.049），同时就诊方式（95%可信区间：0.198~0.711，P = 0.003）及保险类型（95%可信区间：0.004~0.587，P = 0.018）也与院前时间延长有关。

结论

女性与STEMI患者PHDT相关。

关键词: 性别因素, 心肌梗塞, 院前延迟时间

Objective

To investigate the effect of sex factor on pre-hospital delay time (PHDT) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 447 patients with STEMI from April 2014 to November 2015 were divided into the male group (371 cases) and female group (76 cases). The age, diabetes, hypertension, hyperlipemia, smoking history, coronary heart disease, cerebrovascular disease, way of seeking medical care, PHDT and type of medical treatment insurance were recorded and compared. Meanwhile, the PHDT were categorized into five groups:< 3 h group,> 3-6 h group,> 6 - 12 h group,> 12 - 24 h and> 24 h group. Logistics regression model was used to investigate sex and other factors on PHDT in patients with STEMI.

Results

The age in the female group were much higher than that in the male group [(64 ± 8) vs. (56 ± 11), t = 1.040, P = 0.001], and the PHDT in the female group was much longer than that in the male group [(396 ± 38) min vs. (367 ± 30) min, t = 1.219, P = 0.017]. The type of medical treatment insurance also showed singificant differences between the two groups (χ² = 5.500, P = 0.007). Meanwhile, the multivariate Logistic regression analysis revealed that the female patients with STEM I (95% confidence interval: 0.216 - 0.981, P = 0.049), way of seeking medical care (95% confidence interval: 0.198 - 0.711, P = 0.003), the type of medical treatment insurance (95% confidence interval: 0.004 - 0.587, P = 0.018) were associated with PHDT.

Conclusion

The female sex was associated with PHDT in STEMI patients.

Key words: Sex factors, Myocardial infarction, Pre-hospital delay time

表1 急性心肌梗塞患者的临床资料特征及一般情况

组别	例数	年龄（岁， ± s）	糖尿病[例(%)]	高血压[例(%)]	高脂血症[例(%)]	吸烟[例(%)]
男性	371	56 ± 11	89(19.911)	194(43.400)	28(6.264)	247(55.257)
女性	76	64 ± 8	89(19.911)	57(12.752)	5(1.119)	18(4.027)
t/χ²值	?	1.040	1.012	1.308	0.875	1.254
P值	?	0.001	0.010	<0.001	0.128	<0.001
组别	例数	冠心病[例(%)]	脑血管疾病[例(%)]	EMS方式就诊[例(%)]	院前延迟时间（min， ± s）
男性	371	18(4.027)	21(4.698)	61(13.647)	367 ± 30
女性	76	5(1.119)	12(2.685)	21(4.698)	396 ± 38
t/χ²值	?	0.428	1.031	1.020	1.219
P值	?	0.196	0.001	0.011	0.017

表1 急性心肌梗塞患者的临床资料特征及一般情况

组别	例数	年龄（岁， ± s）	糖尿病[例(%)]	高血压[例(%)]	高脂血症[例(%)]	吸烟[例(%)]
男性	371	56 ± 11	89(19.911)	194(43.400)	28(6.264)	247(55.257)
女性	76	64 ± 8	89(19.911)	57(12.752)	5(1.119)	18(4.027)
t/χ²值	?	1.040	1.012	1.308	0.875	1.254
P值	?	0.001	0.010	<0.001	0.128	<0.001
组别	例数	冠心病[例(%)]	脑血管疾病[例(%)]	EMS方式就诊[例(%)]	院前延迟时间（min， ± s）
男性	371	18(4.027)	21(4.698)	61(13.647)	367 ± 30
女性	76	5(1.119)	12(2.685)	21(4.698)	396 ± 38
t/χ²值	?	0.428	1.031	1.020	1.219
P值	?	0.196	0.001	0.011	0.017

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Effect of sex factor on pre-hospital system delay in patients with ST-segment elevation myocardial infarction

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Effect of sex factor on pre-hospital system delay in patients with ST-segment elevation myocardial infarction