急性心肌梗塞病人前驅症狀之相關因素

Factors Related to Prodromal Symptoms in Patients With Acute Myocardial Infarction

"背景：急性心肌梗塞（acute myocardial infarction, AMI）發生前，病人可能經歷前驅症狀（prodromal symptoms, PSs），延遲院前求醫。目的：探討AMI病人性別、年齡、急性症狀、院前延遲時間與PSs之相關。方法：採橫斷性研究設計，以方便取樣在南部某醫學中心急診室招募121位個案。研究工具包含人口學與疾病變項、急性症狀、McSweeney心肌梗塞前驅症狀量表及院前延遲時間。以卡方檢定、費雪爾精確檢定及斯皮爾曼相關法分析變項間的相關，以二元羅吉斯迴歸分析重要的決定因子。結果：83.5％個案曾經歷PSs，PSs得分與年齡（ρ＝-.20, p＜.05）及配偶（Z＝2.23, p＜.05）達顯著相關。個別PSs在性別達顯著差異者為「左胸疼痛或不適」、「小腿疼痛或不適」及「頭痛強度增加」，在年齡分層達顯著差異的只有「胸部中間疼痛或不適」。羅吉斯迴歸發現40－64歲族群出現PSs的勝算比是65歲及以上者的3.19倍。結論／實務應用：AMI的PSs應納入醫學教育課程，提升專業人員對PSs的認知與警覺心，繼而加強對民眾衛教內涵，增強對PSs症狀與AMI連結認知，以及早就醫。"

Background: Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization. Purpose: This study was designed to identify the relationship between PSs and demographics, including gender and age, acute symptoms, and pre-hospital delay time, in patients with AMI. Methods: A cross-sectional study design was applied, and a convenience sampling approach was used to recruit 121 patients in the emergency room of a medical center located in southern Taiwan. Instruments, including a demographic and disease variables datasheet, acute symptoms of AMI, McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), and pre-hospital delay time, were used. Chi-square, Fisher exact, and Spearman correlation coefficients tests were used to examine the respective relationships between the targeted variables and PSs. Binary logistic regression analysis was used to determine the important determinants of PSs. Results: Most (83.5%) of the participants had experienced PSs. The MAPMISS score was significantly associated with age (ρ= -.20, p < .05) and marital status (Z = 2.23, p < .05). Three prodromal symptoms, including pain or discomfort in left breast, pain or discomfort in the legs, and change in headache intensity, were significantly different between male and female participants. Only one symptom, pain or discomfort in the central high chest area, differed significantly among age groups. Binary logistic regression analysis found that participants in the 40-60 years old age group were 3.19 times more likely to develop PSs than their peers in the 65 years old and older group. Conclusions/ Implications for Practice: The results of this study suggest that PSs should be incorporated into medical education to increase the cognition and awareness of healthcare professionals toward PSs and to improve patient education overall in order to strengthen public awareness regarding the relationship between PSs and AMI and subsequently increase the timeliness of their seeking appropriate medical help.