伍满燕,陈红,宋俊贤,李忠佑,李素芳,王立娜,刘俊

• 1:北京大学人民医院心内科
• 2:急性心肌梗死早期预警和干预北京市重点实验室
• 3:北京大学人民医院心血管转化医学研究中心

摘要(Abstract)：

目的探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者拒绝或延迟签署直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)知情同意书的影响因素。方法连续入选2014年8月至2016年3月经北京大学人民医院急/门诊初诊的急性STEMI患者229例。查阅病历和STEMI救治时间记录表并收集资料,将发病时间≤12 h的180例患者纳入最终研究对象,依据决策结果分为接受直接行PCI组和拒绝直接行PCI组,依据决策时间分为知情同意时间<30 min组和知情同意时间≥30 min组。采用单因素和多因素分析识别拒绝或延迟签署直接行PCI知情同意书的相关因素。结果接受直接行PCI组139例,拒绝直接行PCI组41例。多因素logistic回归分析显示,症状缓解(OR 5.532,95%CI 1.165~26.278,P=0.031)、症状剧烈(OR 0.094,95%CI 0.034~0.260,P<0.001)、慢性肾病史(OR 4.786,95%CI 1.346~17.011,P=0.016)是影响患者或亲属签署直接行PCI知情同意书的重要因素。接受直接行PCI组中救治时间点记录完整者106例,知情同意中位时间为24 min,其中知情同意时间<30 min者64例,知情同意时间≥30 min者42例。多因素logistic回归分析显示,症状至就诊时间≥4 h(OR 4.563,95%CI 1.682~12.385,P=0.003)是患者或亲属延迟签署直接行PCI知情同意书的影响因素。结论发现症状缓解及合并慢性肾病患者更容易拒绝签署直接行PCI知情同意书,但症状剧烈的患者更易接受签署直接行PCI知情同意书,而对于最终接受直接行PCI的患者,症状至就诊时间≥4 h是直接行PCI知情同意书签署延迟的影响因素。

关键词(KeyWords)： 知情同意;心肌梗死;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划重大项目(D141100003014002)

作者(Author): 伍满燕,陈红,宋俊贤,李忠佑,李素芳,王立娜,刘俊

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