冠心病住院患者二级预防用药现状调查—附1150例分析

发布时间：2018-06-07 03:20

本文选题：冠心病 + 二级预防　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:冠心病是发达国家的主要死亡原因,随着我国人民饮食习惯改变和生活水平提高,心血管疾病发病率和死亡率急剧升高,已成为危害人群健康的主要杀手,罹患冠心病的人群数量庞大,急性心肌梗死幸存者后续发病风险和死亡率是普通人群的1.5-15倍[1]。近几十年来国内外心血管领域一直致力于冠心病的救治与预防,如何提高心血管病的防治水平,以改善心血管病患者的长期预后是目前亟待解决的重要问题。大规模临床随机试验不断的实施与更新,提供了有力的循证医学证据。国际上各国指南一致推荐,除了持续改变生活方式外,应用抗血小板、β受体阻滞剂(BBs),他汀类调脂药物、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)四种药物组合作为冠心病二级预防治疗的基石,可以显著减少心力衰竭、脑卒中、猝死或再梗死等一系列心血管事件的发生,提高CHD患者的生存率。目的:调查冠心病二级预防用药现状以及与用药相关的影响因素,了解临床实际与指南之间存在的差异,为临床医生治疗冠心病提供资料参考,促进其规范化用药。方法:收集2011年1月到2015年12月从我院心内科出院的明确诊断为冠心病的患者的临床资料,采用回顾性研究的方法,对所纳入人群的一般特点,有循证依据的冠心病二级预防药物,包括抗血小板、他汀类药物、β受体阻滞剂和ACEI/ARB,其出院带药情况以及用药影响因素进行统计和分析,P0.05有统计学意义。结果:⑴符合条件的冠心病患者共1150例,男性806例(70.1%),女性344例(29.9%),平均年龄63.1±6.4岁,其中约1/3患者有心肌梗死病史,超过2/3的患者接受过血运重建,合并症比例从高到低依次为高脂血症736例(64.0%),高血压702例(61.0%),糖尿病414例(36.0%),心力衰竭172例(15.0%),缺血性脑卒中62例(5.4%),慢性肾病39例(3.4%);⑵指南推荐药物服用情况:抗血小板药物服用率最高为98.5%,他汀类97.8%,β受体阻滞剂55.7%,ACEI/ARB服用率最低为38.3%;⑶多因素回归分析显示:抗血小板和他汀类药物在接受血运重建、高脂血症、无心力衰竭组使用率高,β受体阻滞剂在心肌梗死、高血压、高脂血症、心力衰竭组使用率高,ACEI/ARB类在高血压、心力衰竭组使用率高,差异均有统计学意义(P0.05)。结论:从冠心病二级预防出院带药情况来看,抗血小板、他汀类药物的使用率高,基本能够遵循指南的建议,而β受体阻滞剂、ACEI/ARB药物使用情况不甚理想,与指南要求差距大,需引起重视,故而临床上仍需坚持对医生的继续教育,同时加强患者慢性疾病的管理,提高患者对疾病的认知度,使用药更加个体化合理化,增加用药依从性,尽可能降低死亡风险,改善患者生存质量。
[Abstract]:Background: coronary heart disease (CHD) is the main cause of death in developed countries. With the change of dietary habits and the improvement of living standards, the morbidity and mortality of cardiovascular diseases have increased sharply, and have become the main killers of the health of the population. The number of people suffering from coronary heart disease (CHD) is large, and the risk of subsequent morbidity and mortality of survivors of acute myocardial infarction is 1.5-15 times higher than that of the general population. In recent decades, the field of cardiovascular disease at home and abroad has been committed to the treatment and prevention of coronary heart disease, how to improve the level of prevention and treatment of cardiovascular disease in order to improve the long-term prognosis of cardiovascular disease patients is an important issue to be solved. Large-scale randomized trials continue to be implemented and updated to provide strong evidence-based medical evidence. In addition to continuing lifestyle changes, international guidelines have consistently recommended the use of antiplatelet, beta-receptor blockers, and statin lipids. The combination of angiotensin converting enzyme inhibitor / angiotensin receptor antagonist ACEI / ARB as the cornerstone of secondary preventive therapy for coronary heart disease can significantly reduce heart failure and stroke. A series of cardiovascular events, such as sudden death or re-infarction, increase the survival rate of CHD patients. Objective: to investigate the current situation of secondary prophylaxis of coronary heart disease (CHD) and its influencing factors, to understand the differences between clinical practice and guidelines, to provide references for clinicians in the treatment of coronary heart disease and to promote their standardized drug use. Methods: from January 2011 to December 2015, the clinical data of patients with coronary heart disease (CHD) who were discharged from our hospital from cardiology department were collected, and the general characteristics of the people involved were analyzed by retrospective study. Evidence-based coronary heart disease prevention drugs, including anti-platelet, statins, 尾 -receptor blockers and ACEI / ARB, the discharge drug status and drug use factors were statistically significant. Results there were 1150 patients with coronary heart disease who met the criteria of 1: 1, 806 men with 70.1 and 344 women with an average age of 63.1 卤6.4 years. About one third of the patients had a history of myocardial infarction, and more than two thirds of the patients had undergone revascularization. The incidences of complications from high to low are 736 cases of hyperlipidemia (64.0%), 702 cases of hypertension (61.0%), 414 cases of diabetes (36.0%), 172 cases of heart failure (15.0%), 62 cases of ischemic stroke (62 cases) and 39 cases of chronic nephropathy (39 cases). The highest drug use rate was 98.5%, statin 97.8am, 尾 receptor blocker 55.7% ACEI / ARB lowest 38.3% multivariate regression analysis showed that antiplatelet and statins were undergoing revascularization. The utilization rate of 尾 receptor blockers in myocardial infarction, hypertension, hyperlipidemia, heart failure group was high ACEI / ARB group was high in hypertension and heart failure group, the difference was statistically significant (P 0.05). Conclusion: according to the condition of secondary prevention and discharge from coronary heart disease, the use of antiplatelet and statins is high and can basically follow the recommendations of the guidelines, while the use of 尾 receptor blocker ACEI / ARB is not very good, which is far from the requirements of the guidelines. We should pay attention to it, so we still need to insist on continuing education for doctors, strengthen the management of patients' chronic diseases, improve the patients' awareness of the disease, rationalize the use of drugs more individualized, and increase the compliance of drug use, at the same time, it is necessary to strengthen the management of patients' chronic diseases. Minimize the risk of death and improve the patient's quality of life.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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