【作者】 李倩；

【导师】 臧渝梨； 陈玉国；

【作者基本信息】 山东大学 ， 护理学， 2018， 硕士

【摘要】 目的系统研究急诊就诊的心肌梗死(Acute Myocardial Infarction,AMI)患者胸痛等症状的性别化特征,为提高医务人员对AMI典型症状和非典型症状的性别差异的了解,提高临床诊断效率,改善患者的预后,为加强公众卫生教育提供参考依据。方法2015年8月至2017年9月,采用前瞻性连续纳入的方法,自某大学附属大型三甲综合医院急诊胸痛中心纳入符合标准的AMI患者。以自制的病例报告表为研究工具,由3名研究护士 24小时轮流交替负责收集资料,研究护士需事先统一培训,熟悉病例报告表的每项内容。本研究中报告表内容主要包括四部分内容:个人基本信息表、院前及接诊信息、AMI患者症状评估以及急诊检查与治疗。采用描述性统计分析、卡方检验等方法对AMI患者的基本状况、疼痛或不适症状的性质、部位和程度,对非典型症状,诱发/加重和缓解因素等进行统计分析。结果共收集到病例报告表685份,全部有效,研究对象的平均年龄为65.3±11.9岁,女性患者有233人,男性患者有452人,男女比例为1.94:1,与性别有关的结果见下:1.AMI患者既往史存在性别差异,有显著性别差异的既往史有五组:既往经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)(女性 10.3%vs.男性17.7%)、既往造影≥50%狭窄(女性16.7%vs.男性24.1%)、糖尿病(女性45.5%vs.男性25.2%)、高血压(女性72.5%vs.男性60%)和心力衰竭史(女性6.9%v.男性2.2%)。除了既往PCI和既往造影≥50%狭窄外,其余三组既往史均为女性患者的比例要高于男性患者的比例。女性吸烟史的比例低于男性,女性中只有8.6%的患者既往或正在吸烟,然而男性中有64.2%的既往或正在吸烟,以上差异有统计学意义(P<0.05)。2.AMI患者对于疼痛性质的描述中,男性患者中最常见的前三位为:闷痛(18.1%)、压榨样痛(9.5%)、胀痛(7.7%);女性患者最常见的前三位是:闷痛(14.2%)、胀痛(8.6%)、压榨样痛(7.3%)。疼痛程度均是中度疼痛占比最多(女性55.8%vs.男性54.8%)。两性之间疼痛性质和程度无明显的差异(所有P>0.05)。AMI患者中,女性出现放射痛的频率高于男性(女性41.6%vs.男性29.2%),且性别间的差异有统计学意义(P<0.05)。3.AMI患者疼痛或不适部位的描述中,男性患者中疼痛或不适部位按照比例占前三的依次是:左胸部(34.1%)、胸部正中(28.1%)、整个胸部(6.6%);在女性患者中,按照比例占前三位为:胸部正中(30.9%)、左胸部(29.6%)、整个胸部(7.7%)。胸部以外的疼痛或不适部位在男、女性患者中最常见的均为上腹部(女性2.2%s.男性4.3%)。两性在疼痛部位上的差异无统计学意义(所有 P>0.05)。4.AMI患者的非典型症状中,有3组在两性之间存在着明显的差异(P<0.05),且在女性患者中出现的概率更高,分别是:恶心(女性35.2%vs.男性18.4%)、呕吐(女性19.7%vs.男性8.6%)和头晕(女性12%vs.男性6%)。5.AMI患者中,最常见的诱发或加重因素为劳累(女性16.7%vs.男性15.7%),最常见的缓解因素为速效救心丸(女性25.3%vs.男性20.1%),且两性间的差异无统计学意义(所有P>0.05)。结论1.AMI患者的平均年龄女性明显高于男性。2.AMI疾病危险因素上:男性AMI患者的吸烟率明显高于女性患者,而女性AMI患者合并糖尿病、高血压疾病概率明显高于男性患者。3.在男性和女性AMI患者中,胸痛都是最常见的症状;但女性患者相较于男性患者,更容易表现出恶心、呕吐、头晕的非典型症状。4.AMI患者胸痛的部位、性质和程度无显著的性别差异,但是女性往往更容易出现放射痛。更多还原

【Abstract】 ObjectiveThis study was to investigate the characteristics of chest pain related symptoms and gender differences in this regard among patients with acute myocardial infarction(AMI).It would help health care workers to be clear about the gender difference in typical and atypical symptoms,contributing to better diagnosis,prognosis and public health education outcomes.MethodsA consecutive sampling strategy was use to recruit eligible AMI patients from the Chest Pain Center in the university affiliated tertiary hospital from August 2015 to September 2017.Three research nurses took turns to collect data around the clock using the predesigned case report form after the specific training and getting familiar with each item.The Form was consisted of four parts,a.basic information sheet,b.pre-hospital and initial contact details,c.AMI symptoms assessment,and d.examination and treatment in emergency.Descriptive analysis and Chi-square test were performed to analyze patients’ background information,pain and other discomforts of relevancy in aspects of sites,nature,severity,atypical symptoms,as well as precipitating and relieving factors.ResultsA total of 685 case report forms were gathered,and all were valid.These AMI patients were65.3±11.9 years(x±s)old,and the ratio of male to female was 1.94:1(233:452).Gender differences were identified in aspects of health history,nature of chest pain,site of pain,atypical symptoms as well as precipitating and relieving factors.The following are details about these gender differences.1.Gender difference in health history:More male reported the history of percutaneous coronary intervention(PCI,17.7%male vs.10.3%female)and had the sign of over 50%stenosis in the angiographic examination(16.7%male vs.24.1%female).As to the comorbidity of diabetes(45.5%female vs.25.2%male)and hypertension(72.5%female vs.60%male)as well as the history of heart failure(6.9%female vs.2.2%male),more female patients reported the diseased conditions than male patients.The proportion of female smoking history is lower than that of males,only 8.6%of females have been or are smoking,but 64.2%of males have been or are smoking,this difference is statistically significant(P<0.05).2.Description of the chest pain:The first three most frequently reported perception of chest for male patients were oppressive pain(18.1%),squeezing pain(9.5%),and distending pain(7.7%);while that for female patients were oppressive pain(14.2%),distending pain(8.6%),and squeezing pain(7.3%).Slightly more than half of patients reported the moderate degree of such pain(55.8%female vs.54.8%male),but no significant difference was detected about the perception of chest pain(all P>0.05).More female patients reported the occurrence of radiant pain(41.6%female vs.29.2%male),while this gender difference is statistically significant(P<0.05).3.Site of pain:The first three most frequently reported site of pain for male patients were left chest(34.1%),middle chest(28.1%),and whole chest(6.6%),while that for female patients were middle chest(30.9%),left chest(29.6%)and whole chest(7.7%).The most frequently reported site of pain and discomfort outside the chest was the upper abdomen for both male and female patients.4.Atypical symptoms:The most frequently reported atypical symptom was the perception of chest tightness for both female and male(36.9%female vs.33.8%male).Gender difference(all P<0.05)were found in three atypical symptoms,that is,nausea(35.2%femalevs.18.4%male),vomiting(19.7%female vs.8.6%male)and dizziness(12%femalevs.6%male).5.Precipitating and relieving factors:the most common precipitating or aggravating factor is tiredness for both female and male patients(15.7%femalevs.16.7%male).The most common relieving factor for all patients was the use of quick acting Kyushin Pills(25.3%female vs.20.1%male).However no significant difference(all P>0.05)was identified in this regard.ConclusionsOn average female AMI patients were older than male patients.Significant gender difference was found in aspects of the comorbidity of diabetes and/or hypertension and theperception of atypicalsymptoms,but not on other aspects of chest pain.更多还原