ISSN 2096-7446 CN 10-1655/R
主管:中国科协技术协会
主办:中华护理学会

中华急危重症护理杂志 ›› 2020, Vol. 1 ›› Issue (1): 17-23.

• 论著 • 上一篇    下一篇

影响急性主动脉夹层患者院前就诊时间的多因素研究

黄素芳 肖亚茹 汪晖 严丽 周雁荣 邓娟 李咪琪 周荃   

  • 出版日期:2020-01-10 发布日期:2020-01-21

Multivariate study of pre-hospital time in patients with acute aortic dissection

HUANG Sufang,XIAO Yaru,WANG Hui,YAN Li,ZHOU Yanrong,DENG Juan,LI Miqi,ZHOU Quan   

  • Online:2020-01-10 Published:2020-01-21

摘要: 目的 调查急性主动脉夹层患者院前就诊时间的现状、 影响因素并分析院前就诊时间对出院时转归的影响。 方法 采取便利抽样法,选取武汉市某三级甲等医院心脏大血管外科2018年3月-2019年5月的251例急性主动脉夹层转诊患者,采用自行设计的一般资料收 集表和院前就诊时间调查表收集数据,通过Logistic回归探讨院前就诊时间的影响因素。 结果调查对象的院前就诊时间中位数为568.00 min。 多因素回归分析结果显示,大汗症状、是否为持续性疼痛、旁观者的反应、首诊医院、转诊前有无确诊、收入院方式、经治医院数、转诊距离是急性主动脉夹层患者院前就诊时间的影响因素(P<0.05)。 结论 患者有大汗症状、有持续性疼痛、旁观者的反应为就医措施、首诊医院为三级医院、转诊前已确诊、直接入科这些因素,院前就诊时间较短;经治医院数越多、转诊距离越长,院前就诊时间越长。 需加强医疗机构医务人员对疾病的识别,尽早确诊,减少经治医院数,建议直接转诊到确定性治疗医院的 终治科室,减少院前就诊时间,改善患者出院时的转归。

关键词: 主动脉疾病, 病人转诊, 院前时间, 急症护理

Abstract: Objective To investigate the status and influencing factors of pre-hospital time in patients with acute aortic dissection and to analyze the effect of prehospital time on the outcome at discharge. Methods A total of 251 patients with acute aortic dissection were recruited from March 2018 to May 2019 in the department of car-diac macrovascular surgery of a tertiary first-class hospital in Wuhan by convenient sampling,and those patients were all transferred from other hospitals. The self-designed demographic data collection table and pre-hospital time questionnaire were used to collect data and logistic regression was used to explore the influencing factors of pre-hospital time. Results The median prehospital time was 568.00 minutes,and multiple factors regression analysis showed that the symptoms of sweating,whether it was persistent pain,the reaction of bystander,the first hospital the patient reached,whether there was confirmed diagnosis before referral,the way of admission,the number of hospitals the patients were treated and referral distance were the factors influencing prehospital time of acute aortic dissec-tion patients(P<0.05). Conclusion If the patients had symptoms of sweating and/or persistent pain,bystander re-action was accessing medical treatment,the first hospital was a tertiary hospital,the patients were diagnosed before the referral,admitted directly to the cardiovascular surgery department,then the pre-hospital time was relatively short. In addition,the more hospitals the patient was treated and the longer the referral distance,the longer the pre-hospital time. It is necessary to increase the identification ability of diseases in medical institutions and make early diagnosis,reduce the number of hospitals the patient was transferred. It is suggested that patients should be directly referred to the final department to reduce the pre-hospital time,and improve the outcome.

Key words: Aortic Diseases, Patient Transfer, Pre-hospital Time, Emergency Nursing