性别对ST段抬高型心肌梗死患者确诊后再灌注系统时间延迟的影响

摘要

目的 探讨性别与ST段抬高型心肌梗死(STEMI)患者确诊后再灌注时间(D2R)的影响.方法 连续入选就诊于我院明确诊断为STEMI并接受直接PCI的患者1647例.收集所有入选患者的临床资料以及救治过程的各个时间节点.D2R为心电图确诊至介入再灌注时间.将D2R分为5段:o～3 h、＞3～6 h、＞6～12 h、＞12～24h和＞24 h,建立多元logistic回归模型评价性别及其他危险因素对D2R的影响.结果 女性STEMI患者年龄、既往冠状动脉旁路移植术、既往PCI比例显著高于男性[(65±10)岁vs (60±11)岁,4.3％ vs 1.5％,20.7％ vs17.4％,P＜0.05],且女性患者D2R亦明显长于男性患者[(404±34)min vs (280±14) min,P＜0.01].男性呼叫急救医疗系统方式就诊的比例高于女性(33.1％ vs 10.0％,P=0.021).多元logistic回归分析显示,女性患者与D2R(＞3～6 h和＞12～24 h)延长有关(95 ％CI:1.052～264.306,P=0.046),就诊方式与D2R延长有关(95％CI:1.089～2.751,P=0.013).结论 女性与STEMI患者D2R、就诊方式及呼叫急救医疗系统延迟相关.%Objective To study the effect of sex on reperfusion time delay in ST-segment elevation myocardial infarction (STEMI) patients after diagnosis.Methods A total of 1647 STEMI patients admitted to our hospital were included in this study.Their clinical data and treatment time points were recorded.The reperfusion time delay after diagnosis refers the time from ECG-based diagnosis to PCI.The reperfusion time delay after diagnosis was divided into 0-3 h,＞3-6 h,＞6-12 h,＞12-24 h and ＞24 h.The effect of sex and other risk factors on reperfusion time delay after diagnosis was assessed according to the established logistic regression model.Results The age of female STEMI patients was older than that of male STEMI patients (65±10 years vs 60±11 years,P＜0.05).The rate of past CABG and PCI was significantly higher and the reperfusion time delay was significantly longer in female STEMI patients than in male STEMI patients (4.3 ％ vs 1.5％,20.7％ vs 17.4％,P＜0.05;404±34 min vs 280±14 min,P＜0.01).Multivariate logistic regression analysis showed that female and visiting form were related with the reperfusion time delay for ＞3-6 h and ＞12-24 h (95％CI:1.052-264.306,P=0.046;95％CI:1.089-2.751,P=0.013).Conclusion Female is related with reperfusion time delay,visiting form and call for emergency treatment in STEMI patients.