2006、2011年中国中部农村急性心肌梗死患者住院早期氯吡格雷的应用情况及影响因素

发布时间：2018-04-29 02:16

本文选题：急性心肌梗死 + 氯吡格雷　；参考：《中国医学科学院学报》2017年06期

【摘要】：目的评估2006、2011年中国中部农村地区急性心肌梗死(AMI)患者住院早期氯吡格雷的应用情况,并探讨其应用的影响因素。方法采用两阶段随机抽样设计,抽取中部农村AMI患者代表性样本。第一阶段,采用简单随机抽样确定协作医院。第二阶段,在协作医院中采用系统随机抽样方法,抽取研究病历,提取临床信息,评估住院早期(入院24 h内)氯吡格雷应用率。采用广义估计方程的多水平Logistic回归模型分析影响住院早期氯吡格雷应用的因素。结果共计35家医院的1464份AMI病历纳入研究。中位年龄为65岁,女性患者占30.7%。2006至2011年,AMI患者住院早期氯吡格雷应用率从3.98%增加至48.72%(P0.0001)。多因素模型分析中,高血压患者住院早期氯吡格雷应用率高于非高血压患者(OR=1.65,95%CI=1.21~2.26,P=0.001),吸烟患者更易接受氯吡格雷早期治疗(OR=1.87,95%CI=1.19~2.95,P=0.007),入院时存在胸部不适患者早期氯吡格雷应用率高于未合并胸部不适患者(OR=2.17,95%CI=1.35~3.49,P=0.001)。结论 2006至2011年,我国中部农村AMI患者住院早期氯吡格雷应用严重不足的局面开始改善,但其应用率与指南推荐之间还存在极大差距。因此,亟待全面提高早期氯吡格雷应用,进一步改善AMI患者的临床结局。
[Abstract]:Objective to evaluate the use of clopidogrel in early hospitalization of patients with acute myocardial infarction (AMI) in rural areas of central China in 2006 and 2011 and to explore the influencing factors. Methods A two-stage random sampling design was used to select representative samples of AMI patients from rural areas in central China. In the first stage, simple random sampling was used to determine the cooperative hospital. In the second stage, a systematic random sampling method was used to extract the medical records and clinical information to assess the clopidogrel application rate in the early stage of hospitalization (within 24 hours of admission). Multilevel Logistic regression model with generalized estimation equation was used to analyze the factors affecting clopidogrel application in early hospitalization. Results 1464 AMI cases from 35 hospitals were included in the study. The median age was 65 years old, female patients accounted for 30.7%. The early clopidogrel application rate of AMI patients increased from 3.98% to 48.72% from 2006 to 2011 (P 0.0001). In multifactor model analysis, The early clopidogrel application rate in hypertension patients was higher than that in non-hypertensive patients (OR 1.6595). Smoking patients were more likely to receive clopidogrel early treatment (OR 1.8795 CI 1.192.95U P 0.007). The early clopidogrel application rate in patients with chest discomfort was higher than that in patients without chest discomfort at the time of admission. Conclusion from 2006 to 2011, the situation of severe shortage of clopidogrel in early hospitalization of AMI patients in rural areas of central China began to improve, but there is still a great gap between the application rate and the recommended guidelines. Therefore, it is urgent to improve the early application of clopidogrel and improve the clinical outcome of AMI patients.
【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】：国家卫生和计划生育委员会卫生公益性行业科研专项(201202025、201502009) 国家科技部科技支撑计划(2013BAI09B01、2015BAI12B01、2015BAI12B02) 高等学校学科创新引智计划(B16005)~~
【分类号】：R542.22

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