某三级甲等医院2024年654例急诊胸痛患者流行病学特征分析及相关预测因素分析

Analysis of the Epidemiological Characteristics and Associated Predictive Factors among 654 Patients Presenting with Chest Pain to the Emergency Department of a Grade III, Class A Hospital in 2024

摘要: 目的：分析四川省成都市某三级甲等医院2024年654例急诊胸痛患者的流行病学特点。方法：采用回顾性研究设计，收集2023年12月1日~2024年11月30日四川省成都市某三级甲等医院急诊预检分诊信息登记系统中654例年龄 ≥ 14岁、主诉为胸痛的就诊患者数据。数据收集与质量控制流程如下：由两名研究人员独立从急诊预检分诊信息登记系统中提取患者性别、年龄、就诊时间、主要诊断、就诊时心率等信息，录入Excel 2019数据库；提取完成后，由第三名研究人员随机抽取10%的记录与原始登记系统进行核对，确保数据录入准确率 ≥ 98%；对于存在缺失或矛盾的条目，经三人共同讨论后决定是否纳入或排除。所有研究变量定义如下：年龄以实际就诊登记年龄为准(岁)；性别定义为二分类变量，以女性为参照组，男性赋值为1；分诊季节按就诊日期划分，12月至次年2月为冬季，3月至5月为春季，6月至8月为夏季，9月至11月为秋季；分诊时间按24 h内每2 h为一个时段进行分段；结局变量为是否发生心律失常，定义为二分类变量(发生 = 1，未发生 = 0)，诊断依据急诊科医师根据心电图及临床评估作出的正式诊断记录。采用SPSS 27.0软件进行统计分析。结果：654例急诊胸痛患者中男性略多于女性，分别为341例、313例；年龄15~94岁，平均(47.82 ± 19.20)岁；急诊胸痛患者就诊高峰时段为10:00~11:00，全年在该时段就诊的胸痛患者总人数为102例；全年以3~5月即春季胸痛患者偏多，总共182例；654例主诉为胸痛的患者中241例确诊心律失常，心律失常发生率为36.85%，将其按年龄段划分心律失常发生率时，年龄 ≤ 30岁的发生率为31.21% (49/157例)；年龄 > 30岁且≤60岁的发生率为34.80% (111/319例)；年龄 > 60岁的发生率为45.51% (81/178例)。通过二分类Logistic回归分析得出，在以女性为参照组(男性 = 1)的编码方式下，年龄[比值比(OR) = 1.011，95%置信区间(CI)：1.003~1.020，P < 0.05]与性别[OR = 1.486, 95%CI: 1.074~2.058, P < 0.05]为心律失常发生的危险因素。结论：主诉为胸痛的就诊患者男性多于女性，且就诊高峰时段为10:00~11:00，高发季节为春季(3~5月)。发生心律失常的危险因素为年龄及性别。年龄每增加1岁，心律失常风险增加约1.1%；在控制年龄因素后，女性相较于男性具有更高的心律失常发生风险(OR = 1.486, P < 0.05)。

Abstract: Objective: To analyze the epidemiological characteristics of 654 patients presenting with chest pain to the Grade III, Class A hospital in Chengdu, Sichuan Province, in 2024. Methods: A retrospective analysis was conducted on 654 patients aged ≥14 years presenting with chest pain from emergency triage information registration system at a Grade III, Class A hospital in Chengdu, Sichuan Province, between 1 December 2023 and 30 November 2024. The data collection and quality control process is as follows: Data were extracted from the emergency triage information registration system. Two researchers independently extracted data on gender, age, presentation time, primary diagnosis, and heart rate, which were entered into an Excel 2019 database. A third researcher randomly verified 10% of the entries against the original system to ensure that the data accuracy was ≥98%; for entries with missing or contradictory information, after discussion by the three researchers, a decision was made on whether to include or exclude them. Variables were defined as follows: age (years, continuous); gender (binary, with female as the reference group and male coded as 1); triage season (categorical: December-February as winter, March-May as spring, June-August as summer, September-November as autumn); triage time (categorized into 2-hour intervals over 24 hours); and the outcome variable of arrhythmia (binary: present = 1, absent = 0), diagnosed based on electrocardiogram and clinical assessment by emergency physicians. Statistical analysis was performed using SPSS 27.0 software. Results: Among the 654 emergency department patients presenting with chest pain, males slightly outnumbered females, with 341 and 313 cases respectively; ages ranged from 15 to 94 years, with a mean age of (47.82 ± 19.20) years; the peak time for presentations was between 10:00 and 11:00, with a total of 102 patients presenting during this period throughout the year; the highest number of chest pain patients occurred between March and May, totaling 182 cases; among the 654 patients presenting with chest pain, 241 were diagnosed with arrhythmia, yielding an arrhythmia incidence rate of 36.85%. When the incidence rate was categorized by age group, the rate for those aged ≤30 years was 31.21% (49/157 cases); the incidence rate for those aged >30 and ≤60 was 34.80% (111/319 cases); and the incidence rate for those aged >60 was 45.51% (81/178 cases). Binary Logistic regression analysis, with female as the reference group (male = 1), revealed that age [odds ratio (OR) = 1.011, 95% confidence interval (CI): 1.003~1.020, P < 0.05] and gender [OR = 1.486, 95%CI: 1.074~2.058, P < 0.05] were associated with a higher risk of arrhythmia. Conclusion: Among patients presenting with chest pain as their chief complaint, males outnumbered females; the peak consultation period was between 10:00 and 11:00, and the season with the highest incidence was spring (March-May). The risk factors of arrhythmia are age and gender. The risk of arrhythmia increases by about 1.1% with each age increase. After controlling the age factor, women have a higher risk of arrhythmia than men (OR = 1.486, P < 0.05).