关键词: 心肌梗死, 农村人口, 延迟诊断, 影响因素分析

Abstract: Background　Prehospital delays in acute myocardial infarction（AMI） patients in rural areas are common，but this issue has not been studied well in China.Objective　To investigate the characteristics and associated factors of prehospital delay in rural areas AMI patients in Liaoning province，providing theoretical evidences for delivering targeted interventions.Methods　From August 2010 to February 2012，we enrolled a total of 822 AMI inpatients who received treatment in 15 county-level hospitals of Liaoning province by convenience sampling and surveyed them with a self-developed questionnaire for collecting the following data：sex，age，history of smoking and drinking，medical history（hypertension，hyperlipidemia，diabetes mellitus，stroke，angina and myocardial infarction），history of revascularization treatment，self-treatment for chronic diseases，attack time of AMI（onset season，circadian rhythm），departure time for seeking treatment，arrival time at the hospital，hospital level，prehospital transfer，mode of transport and causes of delay in seeking treatment.Ordinal Logistic regression model was used to analyze the association between these aforementioned factors and prehospital delay.Results　Prehospital delay time in rural areas AMI patients was 140（220） min.In the analysis of ordinal Logistic model，history of diabetes mellitus〔OR=2.368，95%CI（1.501，3.734）〕 and self-treatment for chronic diseases〔OR=0.596，95%CI（0.398，
0.894）〕，circadian rhythm in AMI onset〔6：00-11：59：OR=0.314，95%CI（0.193，0.511）；12：00-17：59：OR=0.458，95%CI（0.276，0.761）〕，departure time for seeking treatment〔6：00-11：59：OR=3.035，95%CI（1.876，4.908）；12：00-17：59：OR=2.189，95%CI（1.326，3.612）〕，prehospital transfer〔indirect transfer with medical measures：OR=4.015，95%CI（2.176，7.407）； indirect transfer without medical measures：OR=3.554，95%CI（1.793，7.044）〕，the mode of transport except ambulance，taxi，vehicle，walking and manual handing〔OR=1.695，95%CI（1.004，2.861）〕，causes of delay in seeking treatment〔way far away：OR=0.083，95%CI（0.058，0.119）； poverty：OR=0.352，95%CI（0.161，0.770）；others：OR=0.584，95%CI（0.393，0.868）〕 were independent associated factors of prehospital delay（P<0.05）．Conclusion　The rural areas AMI patients in Liaoning province have long prehospital delay，which is associated with many factors，such as insufficient recognition of AMI，poor sense of seeking treatment，and relative lack of medical resources.In view of this，greater efforts should be made to publicize the knowledge about this disease and interventions should be taken to improve the poor medical status.

Key words: Myocardial infarction, Rural population, Delayed diagnosis, Root cause analysis