Factors leading to delay in decision to seek treatment in patients with acute pulmonary embolism
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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＞30m i n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：济宁地区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。
Objective To investigate the factors associated with delay in decision to seek treatment in patients with acute pulmonary embolism(PE) in Shandong. Methods This prospective, cross-sectional,multicenter survey was conducted from November 1,2008 and December 31,2009. The participants consisted of 699 patients with acute pulmonary embolism within 24 h of symptom onset to 30 hospitals in Shandong. Data were col ected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off . Results The median(25%,75%) decision delay in PE patients was 60(20,180) min Factors associated with late decision in an univariate analysis were age≥65 years, retirement or unemployment , history of pulmonary embolism,symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends, coworkers or even strangers,unbearable symptoms, dyspnea,sweating, syncope and attribution of symptoms to cardiac origin were related to early decision. Multivariate logistic analysis showed that history of pulmonary embolism, absence of syncope,intermittent symptoms, bearable symptoms and attribution of symptoms to noncardiac origin were independent predictors of decision delay>30min. Patients in the early decision group had more chances to receive acute reperfusion therapies (P=0.001) and shorter time intervals from symptom onset to reperfusion therapies (P<0.001 ) . Conclusions To a great extent patients with PE in Shandong delayed in decision to seek treatment.History of acute pulmonary embolism,symptom characteristics and symptom attribution were associated with decision delay.
NETL
NSTL
万方数据
