【摘要】 目的 探讨漳州市区心脏疾病患者院前急救心电图检查情况。方法 收集2022年1月至2024年12月漳州市急救中心出诊记录中1624例心脏疾病患者的相关资料。回顾性分析心电图检查率及阳性率、不同年龄段心电图异常情况以及误诊情况。结果 1624例患者中805例(49.57%)接受了心电图检查。在接受心电图检查的患者中,641例(79.63%)结果为阳性。2023年与2024年的心电图检查率显著高于2022年(P<0.05),而2022年的心电图阳性率则高于2023年及2024年(P<0.05)。常见心电图异常包括ST-T改变、心律失常、心肌缺血及危急值。心电图异常率随年龄增长而升高,>60岁年龄组的异常率显著高于其他年龄组(P<0.001),且各年龄段均以ST-T改变最为常见。在641例心电图阳性患者中,69例被误诊,总体误诊率为10.76%。其中,急性心肌梗死、心律失常和电解质紊乱的误诊率分别为13.90%、9.28%和55.56%。多因素Logistic回归分析显示,年份、年龄段(30～60岁)以及主诉是否为典型胸痛是心电图检查率的独立影响因素(P<0.05)。与2022年相比,2023年(OR=1.807, 95%CI:1.477～2.212)和2024年(OR=2.694, 95%CI:1.813～4.001)患者接受心电图检查的概率更高;主诉为典型胸痛的患者接受检查的概率是非典型主诉者的3.300倍(OR=3.300, 95%CI:2.058～5.291);30～60岁患者接受检查的概率高于<30岁组(OR=1.406, 95%CI:1.088～1.818),而>60岁组与<30岁组之间差异无统计学意义(P=0.154)。结论 心电图在心脏疾病院前急救中具有重要应用价值,但目前院前急救存在检查率不足,且存在因图形不典型、判读能力不足导致的误诊问题。强化“症状导向”的标准化操作流程并提升急救人员对复杂心电图的识图能力,是改善院前急救质量的关键。更多还原

【Abstract】 Objective To examine the status of prehospital electrocardiogram(ECG) testing among patients with cardiac disease in urban Zhangzhou. Methods We collected data on 1,624 patients with cardiac disease from the dispatch records of the Zhangzhou Emergency Medical Center between January 2022 and December 2024. A retrospective analysis was performed to assess the ECG testing rate and positivity rate, the distribution of ECG abnormalities across age groups, and patterns of misdiagnosis. Results Of 1,624 patients, 805(49.57%) underwent ECG testing. Among those tested, 641(79.63%) had positive findings. ECG testing rates in 2023 and 2024 were significantly higher than in 2022(P<0.05), whereas the ECG positivity rate in 2022 was higher than in 2023 and 2024(P<0.05). Common ECG abnormalities included ST–T changes, arrhythmias, myocardial ischemia, and critical abnormalities. The prevalence of ECG abnormalities increased with age, with the >60-year group exhibiting a significantly higher abnormality rate than other age groups(P<0.001); ST–T changes were the most frequent finding across all ages. Among 641 patients with positive ECGs, 69 were misdiagnosed, yielding an overall misdiagnosis rate of 10.76%. Misdiagnosis rates for acute myocardial infarction, arrhythmias, and electrolyte disturbances were 13.90%, 9.28%, and 55.56%, respectively. Multivariable logistic regression identified calendar year, age 30–60 years, and a chief complaint of typical chest pain as independent predictors of undergoing ECG testing(P<0.05). Compared with 2022, patients were more likely to receive ECG testing in 2023(OR=1.807, 95%CI: 1.477～2.212) and 2024(OR=2.694, 95%CI: 1.813～4.001); patients with typical chest pain were 3.300 times as likely to be tested(OR=3.300, 95%CI: 2.058～5.291). Patients aged 30–60 years were more likely to be tested than those aged<30 years(OR=1.406, 95%CI: 1.088～1.818), whereas the difference between the >60-year group and the<30-year group was not statistically significant(P=0.154). Conclusion ECG plays a pivotal role in prehospital emergency care for cardiac diseases; however, current prehospital practice shows suboptimal testing rates and a nontrivial rate of misdiagnosis, attributable to atypical tracings and limited interpretation skills. Strengthening standardized, symptom-directed workflows and enhancing emergency personnel’s competence in interpreting complex ECGs are key to improving the quality of prehospital emergency care.更多还原