急性心肌梗塞病人前驅症狀之相關因素

Factors Related to Prodromal Symptoms in Patients With Acute Myocardial Infarction

10.6224/JN.202104_68(2).06

吳柏勲(Bo-Hsun WU)；詹世鴻(Shih-Hung CHAN)；邱艷芬(Yann-Fen CHAO)；陳幸眉(Hsing-Mei CHEN)

心肌梗塞 ； 前驅症狀 ； 急性症狀 ； 院前延遲時間 ； acute myocardial infarction ； prodromal symptoms ； acute symptom ； pre-hospital delay time

護理雜誌

68卷2期（2021 / 04 / 01）

32 - 42

繁體中文

背景：急性心肌梗塞（acute myocardial infarction, AMI）發生前，病人可能經歷前驅症狀（prodromal symptoms, PSs），延遲院前求醫。目的：探討AMI病人性別、年齡、急性症狀、院前延遲時間與PSs之相關。方法：採橫斷性研究設計，以方便取樣在南部某醫學中心急診室招募121位個案。研究工具包含人口學與疾病變項、急性症狀、McSweeney心肌梗塞前驅症狀量表及院前延遲時間。以卡方檢定、費雪爾精確檢定及斯皮爾曼相關法分析變項間的相關，以二元羅吉斯迴歸分析重要的決定因子。結果：83.5％個案曾經歷PSs，PSs得分與年齡（ρ= - .20, p ＜ .05）及配偶（Z = 2.23, p ＜ .05）達顯著相關。個別PSs在性別達顯著差異者為「左胸疼痛或不適」、「小腿疼痛或不適」及「頭痛強度增加」，在年齡分層達顯著差異的只有「胸部中間疼痛或不適」。羅吉斯迴歸發現40－64歲族群出現PSs的勝算比是65歲及以上者的3.19倍。結論／實務應用：AMI的PSs應納入醫學教育課程，提升專業人員對PSs的認知與警覺心，繼而加強對民眾衛教內涵，增強對PSs症狀與AMI連結認知，以及早就醫。

Background: Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization. Purpose: 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. Methods: 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. Results: 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.

1. Ängerud, K. H.,Sederholm Lawesson, S.,Isaksson, R.-M.,Thylén, I.,Swahn, E.(2019).Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST-and non-ST-elevation myocardial infarction.European Heart Journal: Acute Cardiovascular Care,8(3),201-207.
2. Bahr, R.,Christenson, R.,Farin, H.,Hand, M.,Long, J. M.(2001).Prodromal symptoms of acute myocardial infarction: Overview of evidence.Maryland Medicine,Suppl.,49-59.
3. Barrett-O’Keefe, Z.,Lee, J. F.,Ives, S. J.,Trinity, J. D.,Witman, M. A.,Rossman, M. J.,Groot, H. J.,Sorensen, J. R.,Morgan, D. E.,Nelson, A. D.,Stehlik, J.,Richardson, R. S.,Wray, D. W.(2019).α-adrenergic receptor regulation of skeletal muscle blood flow during exercise in heart failure patients with reduced ejection fraction.American Journal of Physiology-Regulatory,316(5),R512-R524.
4. Beaton, D. E.,Bombardier, C.,Guillemin, F.,Ferraz, M. B.(2000).Guidelines for the process of cross-cultural adaptation of self-report measures.Spine,25(24),3186-3191.
5. DeVon, H. A.,Pettey, C. M.,Vuckovic, K. M.,Koenig, M. D.,McSweeney, J. C.(2016).A review of the literature on cardiac symptoms in older and younger women.Journal of Obstetric, Gynecologic, & Neonatal Nursing,45(3),426-437.
6. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A.-G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
7. Gärtner, C.,Walz, L.,Bauernschmitt, E.,Ladwig, K.-H.(2008).The causes of prehospital delay in myocardial infarction.Deutsches Arzteblatt International,105(15),286-291.
8. Glickman, S. W.,Shofer, F. S.,Wu, M. C.,Scholer, M. J.,Ndubuizu, A.,Peterson, E. D.,Granger, C. B.,Cairns, C. B.,Glickman, L. T.(2012).Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction.American Heart Journal,163(3),372-382.
9. Hwang, S. Y.,Zerwic, J. J.,Jeong, M. H.(2011).Impact of prodromal symptoms on prehospital delay in patients with first-time acute myocardial infarction in Korea.The Journal of Cardiovascular Nursing,26(3),194-201.
10. Khan, N. A.,Daskalopoulou, S. S.,Karp, I.,Eisenberg, M. J.,Pelletier, R.,Tsadok, M. A.,Dasgupta, K.,Norris, C. M.,Pilote, L.(2016).Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger.Heart,103(11),863-869.
11. Khraim, F. M.,Carey, M. G.(2009).Predictors of pre-hospital delay among patients with acute myocardial infarction.Patient Education and Counseling,75(2),155-161.
12. Larson, M. K.,Walker, E. F.,Compton, M. T.(2010).Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders.Expert Review of Neurotherapeutics,10(8),1347-1359.
13. Liu, C.-W.,Liao, P.-C.,Chen, K.-C.,Chiu, Y.-W.,Liu, Y.-H.,Ke, S.-R.,Wu, Y.-W.(2017).Relationship of serum uric acid and Killip class on mortality after acute ST-segment elevation myocardial infarction and primary percutaneous coronary intervention.International Journal of Cardiology,226(1),26-33.
14. Løvlien, M.,Johansson, I.,Hole, T.,Schei, B.(2009).Early warning signs of an acute myocardial infarction and their influence on symptoms during the acute phase, with comparisons by gender.Gender Medicine,6(3),444-453.
15. Mackay, M. H.,Ratner, P. A.,Nguyen, M.,Percy, M.,Galdas, P.,Grunau, G.(2014).Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature.European Journal of Cardiovascular Nursing,13(6),483-493.
16. McSweeney, J. C.,Cleves, M. A.,Zhao, W.,Lefler, L. L.,Yang, S.(2010).Cluster analysis of women’s prodromal and acute myocardial infarction symptoms by race and other characteristics.The Journal of Cardiovascular Nursing,25(4),311-322.
17. McSweeney, J. C.,Cody, M.,O’Sullivan, P.,Elberson, K.,Moser, D. K.,Garvin, B. J.(2003).Women’s early warning symptoms of acute myocardial infarction.Circulation,108(21),2619-2623.
18. McSweeney, J. C.,O’Sullivan, P.,Cody, M.,Crane, P. B.(2004).Development of the McSweeney acute and prodromal myocardial infarction symptom survey.The Journal of Cardiovascular Nursing,19(1),58-67.
19. Mehta, L. S.,Beckie, T. M.,DeVon, H. A.,Grines, C. L.,Krumholz, H. M.,Johnson, M. N.,Lindley K. J.,Vaccarino, V.,Wang, T. Y.,Watson, K. E.,Wenger, N. K.(2016).Acute myocardial infarction in women: A scientific statement from the American Heart Association.Circulation,133(9),916-947.
20. Menees, D. S.,Peterson, E. D.,Wang, Y.,Curtis, J. P.,Messenger, J. C.,Rumsfeld, J. S.,Gurm, H. S.(2013).Door-toballoon time and mortality among patients undergoing primary PCI.The New England Journal of Medicine,369(10),901-909.
21. Nelesen, R.,Dar, Y.,Thomas, K.,Dimsdale, J. E.(2008).The relationship between fatigue and cardiac functioning.Archives of Internal Medicine,168(9),943-949.
22. Nordin, S.,Palmquist, E.,Claeson, A. S.,Stenberg, B.(2013).The environmental hypersensitivity symptom inventory: Metric properties and normative data from a population-based study.Archives of Public Health,71(1),Article 18.
23. O’Keefe-McCarthy, S.,Ready, L.(2016).Impact of prodromal symptoms on future adverse cardiac-related events: A systematic review.The Journal of Cardiovascular Nursing,31(1),E1-E10.
24. Pride, Y. B.,Piccirillo, B. J.,Gibson, C. M.(2013).Prevalence, consequences, and implications for clinical trials of unrecognized myocardial infarction.The American Journal of Cardiology,111(6),914-918.
25. Saberi, F.,Adib-Hajbaghery, M.,Zohrehea, J.(2014).Predictors of prehospital delay in patients with acute myocardial infarction in Kashan City.Nursing and Midwifery Studies,3(4),Article e24238.
26. Soltani, L.,Sabzevari, S.,Ravari, A.,Mirzaei, T.,Bagherian, B.(2019).The association between risk factors and prodromal myocardial infarction symptoms: A cross-sectional study in Iran.Ethiopian Journal of Health Sciences,29(4),439-446.
27. Stacey, R. B.,Jordan, J.,Whitlock, M.,Hall, M. E.,Vasu, S.,Hamilton, C.,Kitzman, D.,Hundley, W. G.(2017).Abstract 19061: Cardiac stress results forecast adverse cardiovascular events in high risk asymptomatic middle and older aged men: Identification of silent myocardial ischemia in the elderly.Circulation,136(1, Suppl.),Article A19061.
28. Thygesen, K.,Alpert, J. S.,Jaffe, A. S.,Chaitman, B. R.,Bax, J. J.,Morrow, D. A.,White, H. D.(2018).Fourth universal definition of myocardial infarction (2018).Global Heart,13(4),305-338.
29. Wechkunanukul, K.,Grantham, H.,Clark, R. A.(2017).Global review of delay time in seeking medical care for chest pain: An integrative literature review.Australian Critical Care,30(1),13-20.
30. 陳夏蓮, S.-L.,蔡仁貞, J.-C.(2012)。症狀經驗、病因解釋與治療遵從行為—以高血壓病人為例。護理雜誌，59(1)，5-10。
31. 衛生福利部國民健康署（2016，12月）．國民營養健康狀況變遷調查（102–105年 ）。https://www.hpa.gov.tw/Cms/File/Attach/6201/File_12811.pdf [Health Promotion Administration, Ministry of Health and Welfare, Taiwan, ROC. (2016, December). Nutrition and health survey in Taiwan (2013–2016). https://www.hpa.gov.tw/Cms/File/Attach/6201/File_12811.pdf]
32. 衛生福利部統計處（2020，6月16日）．108年度死因統計結果分析。https://dep.mohw.gov.tw/DOS/lp-4927-113.html [Department of Health, Executive Yuan, Taiwan, ROC. (2020, June 16). Cause of death statistics, 2019. https://dep.mohw.gov.tw/DOS/lp-4927-113.html]