Wu Bo-Hsun, Chan Shih-Hung, Chao Yann-Fen, Chen Hsing-Mei
MSN, RN, Assistant Head Nurse, Department of Nursing, Chi Mei Medical Center, Taiwan, ROC.
PhD, MD, Clinical Associate Professor and Attending Physician, Division of Cardiology, National Cheng Kung University Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2021 Apr;68(2):32-42. doi: 10.6224/JN.202104_68(2).06.
Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization.
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.
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.
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.
在急性心肌梗死（AMI）发生之前，患者可能会经历不同的前驱症状（PSs），这可能会延迟他们在住院前寻求医疗救治。
本研究旨在确定AMI患者的前驱症状与人口统计学特征（包括性别和年龄）、急性症状以及院前延迟时间之间的关系。
采用横断面研究设计，并使用便利抽样方法，在位于台湾南部的一家医疗中心的急诊室招募了121名患者。使用了包括人口统计学和疾病变量数据表、AMI急性症状、麦克休尼急性和前驱心肌梗死症状调查（MAPMISS）以及院前延迟时间等工具。采用卡方检验、费舍尔精确检验和斯皮尔曼相关系数检验来检验目标变量与前驱症状之间的各自关系。使用二元逻辑回归分析来确定前驱症状的重要决定因素。
大多数（83.5%）参与者经历过前驱症状。MAPMISS评分与年龄（ρ = -0.20，p < 0.05）和婚姻状况（Z = 2.23，p < 0.05）显著相关。男性和女性参与者在前驱症状方面，有三种前驱症状存在显著差异，包括左乳房疼痛或不适、腿部疼痛或不适以及头痛强度变化。只有一种症状，即胸部中央高处疼痛或不适，在不同年龄组之间存在显著差异。二元逻辑回归分析发现，40 - 60岁年龄组的参与者出现前驱症状的可能性是65岁及以上年龄组同龄人3.19倍。
结论/对实践的启示：本研究结果表明，前驱症状应纳入医学教育，以提高医护人员对前驱症状的认知和意识，并全面改善患者教育，从而加强公众对前驱症状与AMI之间关系的认识，进而提高他们寻求适当医疗帮助的及时性。
