抗血小板药物在中国急性心肌梗死患者中的应用变化趋势调查2001-2011

发布时间：2018-04-14 22:06

本文选题：急性心肌梗死 + 阿司匹林　；参考：《北京协和医学院》2014年博士论文

【摘要】：背景心血管疾病业已成为全球致死与致残的首要原因。急性心肌梗死为冠状动脉粥样硬化性心脏病的危急重症,据世界银行估计,2030年我国心肌梗死患者将达2300万,将会带来严重的社会经济负担。大量临床研究表明,抗血小板药物可以降低急性心肌梗死患者死亡率,己成为治疗急性心肌梗死的重要基石。目前国内外指南,均指出若无明确禁忌症,均应尽早给予阿司匹林和氯吡格雷等抗血小板药物。目前能够代表我国急性心肌梗死整体人群住院期间抗血小板药物应用情况的数据,仍然十分匮乏,因此,了解我国急性心肌梗死整体人群住院期间抗血小板药物真实应用情况,对于政府决策部门制定科学合理的政策具有重要的意义。目的评价中国2001-2011年间急性心肌梗死患者住院间期抗血小板药物应用的变化趋势；了解不同地区、不同医院之间抗血小板药物应用的差异；探讨影响抗血小板药物的使用的因素,为优化抗血小板药物在急性心肌梗死患者中的应用提供科学依据。方法该研究通过随机抽样选取中国162家医院2001年、2006年及2011年急性心肌梗死住院病历进行数据提取,对于抗血小板药物的应用情况进行描述和分析。通过集中式电子化病历信息提取系统,记录抗血小板药物的种类、剂量及使用时间,数据提取的过程采用严格的质量控制,保证了数据真实可靠性。结果在14,041例适合服用阿司匹林的急性心肌梗死患者中,12,988(92.5%)例患者住院期间服用阿司匹林。阿司匹林使用率在2001年、2006年及2011年分别为84.7%(加权率83.6%)、92.3%(加权率92.8%)及94.7%(加权率95.2%),但是在2011年仍有14%农村医院阿司匹林使用率低于80%。入院时合并心源性休克、心脏骤停的患者较未合并的患者阿司匹林使用率较低,接受溶栓或者经皮冠状动脉介入治疗的患者阿司匹林使用率高于未接受上述治疗的患者。在14,057例适合服用氯吡格雷的急性心肌梗死患者中,8772(62.4%)例患者服用氯吡格雷。氯吡格雷的使用率在2001年、2006年及2011年分别为7.7%(加权率8.2%)、49.2%(加权率54.3%)及83.5%(加权率86.3%)。不同地区的氯吡格雷使用率存在显著差异,2001年、2006年及2011年不同地区使用率范围分别为0%-11.8%、4.5%-66.5%及52.7%-93.2%,农村医院氯吡格雷使用率显著低于城市医院。相对于城市医院,农村医院之间氯吡格雷使用率存在差异巨大。其中2011年,农村医院氯吡格雷使用率中位数为60.8%,四分位间距13.3%-93.7%,而城市医院氯吡格雷中位使用率为96.2%,四分位间距为87.9%-99%。接受溶栓或者经皮冠状动脉介入治疗的患者氯吡格雷使用率高于其他患者。具有经皮冠状动脉介入治疗能力医院氯吡格雷使用率高于不具备该治疗能力的医院,教学医院氯吡格雷使用率高于非教学医院。在10,413例入院时无明确替罗非班禁忌症的患者中,1180(11.3%)例患者接受替罗非班治疗。替罗非班使用率由2006年3.5%增加至2011年14.8%。城市医院替罗非班使用率高于农村医院。替罗非班的使用率随着年龄的增加而降低,行经皮冠状动脉介入治疗的患者替罗非班使用率高于未行该治疗的患者,具有经皮冠状动脉介入治疗能力的医院,替罗非班使用率显著高于不具有该治疗能力的医院。结论本研究结果显示抗血小板药物的使用率显著增加,但是仍存在不足之处,尤其农村医院抗血小板药物使用严重不足。因此,各级卫生行政主管部门应制定合理的医疗质量改善政策,努力缩小临床实践与循证医学之间的差距,使抗血小板药物的应用更加合理规范,同时加强对临床医生教育,使其充分认识抗血小板药物在急性心肌梗死患者中积极的预防和治疗作用。只有全社会多方联动,才能根本改善抗血小板药物使用不足的现状。
[Abstract]:Background : Cardiovascular diseases have become the leading cause of global death and disability . Acute myocardial infarction is a critical and critical condition for coronary atherosclerotic heart disease . According to World Bank estimates , the death rate of patients with acute myocardial infarction in 2030 will be 23 million , which will bring serious social and economic burden . At present , it is pointed out that antiplatelet drugs can reduce the mortality of patients with acute myocardial infarction and become an important cornerstone of the treatment of acute myocardial infarction . At present , it is important to understand the actual application of antiplatelet drugs during hospitalization for the whole population of acute myocardial infarction in China . Therefore , it is important to understand the real application of antiplatelet drugs during hospitalization in the whole population of acute myocardial infarction in China .

Objective To evaluate the trend of antiplatelet drugs in patients with acute myocardial infarction between 2001 and 2011 .
To understand the difference of antiplatelet drug use between different hospitals and different hospitals ;
To explore the factors influencing the use of antiplatelet drugs and provide scientific basis for the optimization of antiplatelet drugs in patients with acute myocardial infarction .

Methods The data were extracted from 162 hospitals in China in 2001 , 2006 and 2011 by random sampling . The application of anti - platelet drugs was described and analyzed . Through the centralized computerized medical record information extraction system , the kinds , dosage and usage time of antiplatelet drugs were recorded , and strict quality control was used to ensure the real reliability of data .

Results In 14,41 patients with acute myocardial infarction suitable for aspirin use , 12,988 ( 92.5 % ) of patients received aspirin during hospitalization . The use of aspirin was 84.7 % in 2001 , 92.3 % ( weight rate 92.8 % ) and 94.7 % ( weight rate 95.2 % ) , but in 2011 there were still 14 % of those in rural hospitals with less than 80 % aspirin use .

Of 14,057 patients with acute myocardial infarction suitable for clopidogrel use , 8772 ( 62.4 % ) patients received clopidogrel . The use rate of clopidogrel in 2001 , 2006 and 2011 was 7 . 7 % ( weight ratio 8.2 % ) , 49.2 % ( weight rate 54.3 % ) and 83.5 % ( weight rate 86.3 % ) .

Of the 10,413 patients who had no explicit terofiban contraindications at admission , 1180 ( 11.3 % ) patients were treated with Tirofiban . The use of tirofiban increased from 3.5 per cent in 2006 to 14.8 per cent in 2011 . The rate of use of tirofiban was higher in urban hospitals than in rural hospitals . The use of tirofiban increased with age , and the use of tirofiban was higher in patients with percutaneous coronary intervention than those without the treatment , and the use of tirofiban was significantly higher than in hospitals without the treatment capacity .

Conclusion The results showed that the use of antiplatelet drugs was significantly increased , but there were still some shortages , especially the use of antiplatelet drugs in rural hospitals . Therefore , the competent department of health administration at all levels should formulate rational medical quality improvement policies , try to narrow the gap between clinical practice and evidence - based medicine , make the application of antiplatelet drugs more reasonable , and strengthen the education of clinicians to fully understand the active prevention and treatment of antiplatelet drugs in patients with acute myocardial infarction .

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R542.22

【共引文献】