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1、急性肺栓塞患者决定就医延迟的原因分析赵月霞(济宁市第一人民医院医疗保健部272111)【摘要】目的：调查济宁地区急性肺栓塞患者决定就医延迟程度及影响因素。方法:入选2012年11月至2013年10月底就诊于济宁地区12家医院并与发病后24h内到院的169例急性肺栓塞患者。通过与患者进行结构式访谈及查阅病历,收集资料。以决定就医延迟30min为切点，分为早决定组及晚决定组，对比分析两组资料。结果:中位决定就医延迟为60min。多因素回归分析显示:肺栓塞病史、胸痛不明显、症状不典型、症状能够耐受、对该病的认识不够重视及未将症状归于急性肺栓塞是决定就医延迟〉30min
2、的独立预测因素。早决定组患者具有更高的早期再灌注治疗率及更短的发病至再灌注治疗延迟。结论:济宁地IX急性肺栓塞患者决定就医时间明显延迟，患者耐受情况、症状特点及认知因素影响决定就医延迟程度。【关键词】急性肺栓塞就医延迟【中图分类号】R563.5【文献标识码】A【文章编号】1672-5085(2014)08-0083-02FactorsleadingtodelayindecisiontoseektreatmentinpatientswithacutepulmonaryembolismLVFENG-CHEN,People′sHospitalofJinin
3、gCentralDistrict,Shandong,Jining272000,China【Abstract】ObjectiveToinvestigatethefactorsassociatedwithdelayindecisiontoseektreatmentinpatientswithacutepulmonaryembolism(PE)inShandong.MethodsThisprospective,cross-sectional,multicentersurveywasconductedfromNovember1,2008andDecember31,200
4、9.Theparticipantsconsistedof699patientswithacutepulmonaryembolismwithin24hofsymptomonsetto30hospitalsinShandong.Datawerecollectedbysemi-structuredinterviewsandmedicalrecordsreview.Thepatientswerecategorizedintoanearlydecisiongroupandthealatedecisiongroupbasedonthe30mincut-off.Results
5、Themedian(25%,75%)decisiondelayinPEpatientswas60(20,180)minFactorsassociatedwithlatedecisioninanunivariateanalysiswereage≥65years,retirementorunemployment,historyofpulmonaryembolism,symptomonsetathomeandintermittentsymptoms,whereaspresenceofbystanderssuchasfriends,coworkersorevens
6、trangers,unbearablesymptoms,dyspnea,sweating,syncopeandattributionofsymptomstocardiacoriginwererelatedtoearlydecision.Multivariatelogisticanalysisshowedthathistoryofpulmonaryembolism,absenceofsyncope,intermittentsymptoms,bearablesymptomsandattributionofsymptomstononcardiacoriginwerei
7、ndependentpredictorsofdecisiondelay>30min.Patientsintheearlydecisiongrouphadmorechancestoreceiveacutereperfusiontherapies(P=0.001)andshortertimeintervalsfromsymptomonsettoreperfusiontherapies(P<0.001).ConclusionsToagreatextentpatientswithPEinShandongdelayedindecisiontoseektreatment.H
8、istoryofacut
