Thời gian chậm trễ do bệnh nhân và đặc điểm lâm sàng, cận lâm sàng nhồi máu cơ tim cấp ST chênh lên tại thời điểm nhập viện

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Tác giả: Đỗ Trường Sơn Châu, Duy Phương Đặng, Quang Huân Đỗ, Hữu Huy Đoàn, Công Tấn Lê, Đỗ Anh Nguyễn, Minh Qui Nguyễn, Thái Yên Nguyễn, Thiên Hào Nguyễn, Trung Quốc Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 616.12 Diseases of heart

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 64-79

Bộ sưu tập: Metadata

ID: 500682

Thêm vào giỏ

Determine the "patient delay" interval and factors influencing this time in patients with ST-segment elevation myocardial infarction. Methods: We conduct a cross-sectional study. There are 166 cases of ST-segment elevation myocardial infarction selected. The primary study variable was the time of first medical contact delay or "Patient delay". The secondary study variables were the correlation between "patient delay" and clinical and laboratory characteristics at the time of admission analyzed by univariate and multivariate logistic regression models. Data analysis using R software version 3.5.3 for Windows operating system. Results: The prevalence of patients with acute ST-segment elevation myocardial infarction with "Patient delay" >
180 minutes was 39.8%. "Patient delay" has a median value of 134 minutes with a quartile (69.3 - 300 minutes). Patient delay >
180 minutes compared with the group ≤ 180 minutes were less likely to have symptoms of sweating (63.6% versus 83.0%
p = 0.013), lower proportion of patients with blood pressure ≤ 90 mmHg (1.5% versus 14.0%, p = 0.005), lower proportion of patients with Killip ≥ II (9.1% versus 22.0%, p <
0. 05), higher Troponin T-hs concentration [0.036 (0.10 - 1.49 versus 0.06 (0.02-0.18)
p <
0.001], lower blood sodium concentration [138.0 (135.0 - 139.0) versus 139.0 (136.0 - 140.0)
p = 0.036], higher blood potassium concentration [3.8 (3.6 - 4.0) versus 3.6 (3.3 - 4.0)
p = 0.011]. When univariate logistic regression analysis showed a association between "patient delay" >
180 minutes and age >
60 (OR = 1.96
95% CI: 1.04 - 3.68
p = 0.037), male (OR = 0.4
95% CI: 0.19 - 0.88
p = 0.022) and diabetes (OR = 2.31
95% CI: 1.04 - 4.36
p = 0.038). In multivariable logistic regression analysis, no independent factor associated with "patient delay" was found. Conclusions: The "patient delay" is still long, and the proportion of patients in the group >
180 minutes is still very high, which greatly affects the time when patients receive treatment.Xác định khoảng "thời gian chậm trễ do bệnh nhân" và các yếu tố ảnh hưởng đến thời gian này ở bệnh nhân nhồi máu cơ tim cấp ST chênh lên. Đối tượng và phương pháp nghiên cứu: mô tả cắt ngang. Có 166 trường hợp nhồi máu cơ tim cấp ST chênh lên được chọn. Biến số nghiên cứu chính là thời gian chậm trễ tiếp xúc y tế đầu tiên hay "Thời gian chậm trễ do bệnh nhân". Các biến số nghiên cứu phụ là sự tương quan giữa "Thời gian chậm trễ do bệnh nhân" với các đặc điểm lâm sàng, cận lâm sàng tại thời điểm nhập viện được phân tích bằng mô hình hồi quy logistic đơn biến và đa biến. Phân tích số liệu bằng phần mềm R phiên bản 3.5.3 cho hệ điều hành Windows. Kết quả nghiên cứu: Trong tổng số 166 trường hợp bệnh nhân được đưa vào nghiên cứu, tỷ lệ bệnh nhân nhồi máu cơ tim cấp ST chênh lên có "thời gian chậm trễ do bệnh nhân" >
180 phút là 39,8%. "Thời gian chậm trễ do bệnh nhân" có giá trị trung vị là 134,0 phút với tứ phân vị (69,3 - 300,0) phút. Nhóm có "thời gian chậm trễ do bệnh nhân" >
180 phút so với nhóm ≤ 180 phút thường ít có triệu chứng vã mồ hôi (63,6% so với 83,0%
p = 0,013), tỷ lê bệnh nhân có huyết áp âm thu ≤ 90 mmHg thấp hơn (1,5% so với 14,0%, p = 0,005), tỷ lệ bệnh nhân có Killip ≥ II thấp hơn (9,1% so với 22,0%, p <
0,05) , nồng độ Troponin T-hs cao hơn [0,036 (0,10 - 1,49 so với 0,06 (0,02-0,18)
p <
0,001], nồng độ Natri máu thấp hơn [138,0 (135,0 - 139,0) so với 139,0 (136,0 - 140,0)
p = 0,036], nồng độ Kali máu cao hơn [3,8 (3,6 - 4,0) so với 3,6 (3,3 - 4,0)
p = 0,011] . Khi phân tích hồi quy logistic đơn biến cho thấy, có mối tương quan giữa "thời gian chậm trễ do bệnh nhân" >
180 phút với tuổi >
60 (OR = 1,96
khoảng tin cậy 95%: 1,04 - 3,68
p = 0,037), giới nam (OR = 0,4
khoảng tin cậy 95%: 0,19 - 0,88
p = 0,022) và mắc đái tháo đường (OR = 2,31
khoảng tin cậy 95%: 1,04 - 4,36
p = 0,038). Phân tích hồi quy logistic đa biến, chưa ghi nhận yếu tố liên quan độc lập với "thời gian chậm trễ do bệnh nhân" Kết luận: "Thời gian chậm trễ do bệnh nhân" còn dài , tỷ lệ bệnh nhân trong nhóm >
180 phút còn rất cao gây gây ảnh hưởng đến thời điểm người bệnh được tiếp nhận điều trị.

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