2001年至2011年中国西部农村ST段抬高型心肌梗死诊疗变化趋势——China PEACE回顾性急性心肌梗死研究

发布时间：2018-04-25 20:27

本文选题：心肌梗死 + 治疗学　；参考：《中国循环杂志》2016年04期

【摘要】：目的:评价2001年~2011年中国西部农村ST段抬高型心肌梗死(STEMI)住院患者在临床特征、诊疗模式和结局方面的变化趋势。方法:采用两阶段随机抽样方式。第一阶段,采用分层随机抽样确定西部农村协作医院。第二阶段,采用系统随机抽样方法确定研究病历样本,以5年为间隔选取2001年、2006年和2011年三个时间点作为研究年份,抽取三个年份的住院病历,提取临床诊疗信息。分别对每年度的研究数据进行加权计算,以调整不同抽样概率的影响。所有结果均为加权结果,反映西部农村的整体情况。结果:抽取确定35家西部农村医院中的32家,入选1 028份STEMI病历。2001年~2011年,STEMI住院患者的中位年龄由64(54~70)岁升至67(56~75)岁(趋势P值0.05),性别构成无明显差异。心血管病危险因素如高血压、血脂异常和吸烟在STEMI患者中的比例明显上升。在无相应禁忌证的患者中,入院24 h内阿司匹林使用率由2001年73.6%升至2011年89.9%,氯吡格雷使用率由0%升至66.5%,β受体阻滞剂使用率由25.4%升至64.3%,他汀类药物使用率由7.5%升至89.8%(趋势P值均0.01)。10年间基本无患者接受急诊经皮冠状动脉介入术,从2001年0%至2011年0.3%(趋势P值=0.51);溶栓治疗比例由33.4%升至55.4%(趋势P值0.01),2001年、2006年和2011年再灌注治疗率分别是33.4%、50.7%和55.7%(趋势P值0.01)。2001年、2006年和2011年住院7 d内病死率分别为3.0%、10.1%和6.7%,死亡加放弃治疗率分别为5.3%、12.3%和10.9%,调整后住院7 d内病死率和死亡加放弃治疗率变化均无统计学意义。结论:2001年~2011年,我国西部农村的STEMI患者医疗质量取得了大幅改善,使其与全国其他地区的差距显著缩小,但仍然存在明显不足。
[Abstract]:Objective: to evaluate the clinical features, diagnosis and treatment patterns and outcome of ST-segment elevation myocardial infarction (STEMI) inpatients from 2001 to 2011 in rural areas of western China. Methods: two-stage random sampling was used. In the first stage, stratified random sampling was used to determine the western rural cooperative hospital. In the second stage, the system random sampling method is used to determine the research medical record sample. Three time points, 2001, 2006 and 2011, are selected as the research years, and the clinical diagnosis and treatment information is extracted. The annual data are weighted to adjust the influence of different sampling probability. All results are weighted results, reflecting the overall situation in western rural areas. Results: 32 out of 35 rural hospitals in western China were selected for 1 028 STEMI medical records. The median age of inpatients with STEMI from 2001 to 2011 increased from 64 to 56575 years (trend P = 0.05). There was no significant difference in sex composition. Cardiovascular risk factors such as hypertension, dyslipidemia and smoking increased significantly in STEMI patients. Among patients without corresponding contraindications, The usage rate of aspirin increased from 73.6% in 2001 to 89.9% in 2011, clopidogrel from 0% to 66.5%, 尾 receptor blocker from 25.4% to 64.3%, and statins from 7.5% to 89.8. Patients underwent emergency percutaneous coronary intervention, From 0% in 2001 to 0.3% in 2011 (trend P value 0. 51%; thrombolytic treatment rate rose from 33. 4% to 55. 4%). (trend P value 0. 01%, the reperfusion rates in 2001, 2006 and 2011 were 33. 40.7% and 55. 7%, respectively. In 2001, in 2006 and 2011, the mortality rates were 3. 0% and 10. 1%, respectively. The death and abandonment rates were 5.3% and 10.9%, respectively. There was no significant difference in mortality and mortality within 7 days after adjustment. Conclusion: from 2001 to 2011, the medical quality of STEMI patients in the western rural areas of China has been greatly improved, and the gap between the patients and other regions of the country has been narrowed significantly, but there are still obvious deficiencies.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院中国牛津国际医学研究中心国家心血管疾病临床医学研究中心心血管疾病国家重点实验室;
【基金】：卫生公益性行业科研专项“冠心病医疗结果评价研究和临床转化研究”(201202025) 国家科技支撑计划项目“冠心病医疗质量改善研究”(2013BAI09B01)
【分类号】：R542.22

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