摘要
背景：心血管疾病已经严重威胁人类生命健康和生活质量。急性心肌梗死是其一种类型,也是其危重症,治疗的关键在于患者能否在症状发生后尽早就医实施再灌注治疗,避免诊治延迟,然而影响患者延误诊治的因素是多样的,从患者发病到就诊这个过程中有许多不确定因素会导致患者就医延迟。
目的：本研究旨在1)调查心肌梗死患者在就医延迟时间上是否存在性别差异性2)了解急性心肌梗死患者的知识、态度和信念的现状及其影响因素3)了解急性心肌梗死患者的焦虑、抑郁和否认水平4)探讨最能预测急性心肌梗死患者就医延迟的因素。
方法：本研究采用横断面相关性研究设计,使用“急性冠脉综合征反应指数量表”、“医院焦虑和抑郁量表”、“心血管否认影响指数量表”和笔者自行设计的人口学资料量表,采用方便取样的方法对武汉市三所医院115名急性心肌梗死患者进行了问卷调查。将所得有效数据应用SPSS17.0统计软件包进行分析。
结果：共发放问卷130份,收回126份,回收率96.9%,有效问卷115份,有效率91.3%。研究结果显示：1)心肌梗死患者存在着不同程度的就医延迟(平均时间为6.64小时),女性患者就医延迟的时间明显高于男性,具有统计学差异(P<0.01)。2)患者关于疾病知识的均分为11.51±2.45分,态度的均分为9.73±3.59分,信念的均分为21.37±3.68分；患者的知识受年龄和既往心脏病病史的影响(P<0.05),患者的态度受教育背景和是否独居的影响(P<0.05),患者的信念受性别、年龄、经济状况、教育背景和出现症状的第一反应的影响(P<0.05)。3)患者的心理健康状态欠佳,焦虑和抑郁得分为10.69±5.71分,心血管否认指数得分为33.71±7.69分。4)心肌梗死患者就医延迟时间与性别(P<0.01)、疼痛的程度(P<0.01)、教育背景(P<0.01)和出现症状的第一反应(P<0.01)、居住地区(P<0.05)、经济状况(P<0.05)和对疾病的信念(P<0.05)有关；多因素回归分析显示性别、疼痛的程度、患者出现症状的第一反应和居住地区是患者就医延迟的独立危险因素。
结论：心肌梗死患者的就诊延迟时间受多种因素的影响。医务工作者应在冠心病高风险人群中(尤其是女性患者)开展针对性的健康教育,提高患者疾病相关的知识、态度、信念水平,进一步帮助患者早期识别不典型心脏疾病的症状,重视其心理健康状况,缩短患者决策延迟的时间,有利于疾病的治疗和预后,挽救生命,改善人们健康状况。
Objective:The purpose of this study was to examine gender difference in pre-hospital delay time among the patients with Acute Myocardial Infarction (AMI), assess the knowledge, attitude and beliefs of AMI symptoms, describe the anxiety, depression and cardiac denial level among the patients, and explore the factors related to pre-hospital delay among the patients with AMI.
Method:Based on Leventhal's Self-Regulation Theory, a descriptive, correctional cross-sectional design was used in the study. A convenience sample of115hospitalized patients with AMI participated in the interview after they were physiologically stable. Data were collected via interview using structured questionnaire and scales included Acute Coronary Syndrome (ACS) Response Index, Hospital Anxiety and Depression Scale (HADS), Cardiac Denial of Impact Scale (CDIS) and the demographic questionnaire.
Result:The study findings demonstrated that the participants had a relatively longer pre-hospital delay time (M=6.64hours), there is significant gender difference in delay in seeking treatment for AMI (P<0.01), female delayed longer than male patients, with a mean pre-hospital delay time of12.49hours vs4.76hours. Among115participants, knowledge level of ACS symptoms is insufficient (M=11.51), their attitude of ACS symptoms are not positive (M=9.73) and their beliefs and prompt action of ACS symptoms is limited (M=21.37). There are statistically significant difference of knowledge level based on age and medical history(P<0.05); there are statistically significant difference of attitude scores based on educational background and living with family member or living alone (P<0.05); there are statistically significant difference of beliefs scores based on gender, age, income, educational background and first response to symptoms (P<0.05). Patients in this study reported they have low psychological distress. The mean score on cardiac denial scale is33.71, the mean score on hospital anxiety and depression scale is10.69. There were no relationships among cardiac denial score, anxiety and depression level and pre-hospital delay time. There were numerous significant positive and negative correlations found among gender, income level, educational background, living area, first response to AMI symptoms, beliefs, pain severity and pre-hospital delay time. The study findings revealed that best predictors of pre-hospital delay time were pain severity, gender, first response to AMI symptoms and living areas among the patients.
Conclusion:Interventions intended to decrease patients delay should be aimed at increasing patients'perception and knowledge of AMI symptoms, treatment-seeking behavior, especially for women. The nurses and health care providers should strengthen education and counseling programs that are designed to help the patients with high risk factors to recognize early symptoms and quickly seek medical care when they experience a heart attack.
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