2001年～2011年间中国中部农村急性心肌梗死患者血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的应用及影响因素——Ch

发布时间：2018-10-05 07:42

【摘要】：目的:了解2001年~2011年间中国中部农村急性心肌梗死(AMI)患者血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)的使用情况,并探讨其影响因素。方法:采用"冠心病医疗结果评价和临床转化研究——回顾性急性心肌梗死研究"(以下简称China PEACE回顾性AMI研究)的数据,通过两阶段随机抽样获得2001年、2006年和2011年有代表性的中部农村AMI患者的临床信息。为评估ACEI/ARB使用情况,按照中国指南将患者分为指南Ⅰ类推荐组[包括ST段抬高型心肌梗死(STEMI)和合并心力衰竭、左心室射血分数40%、高血压或糖尿病的非ST段抬高型心肌梗死(NSTEMI)]和指南Ⅱa类推荐组(无Ⅰ类推荐指征的NSTEMI)。为估算出三个研究年份ACEI/ARB的使用率和变化趋势,对每年度的数据分别进行加权计算,以代表中部农村整体情况。采用二元Logistic回归方法分析其使用的影响因素。结果:35家中部农村医院参加研究,入选1 657份AMI病例,其中中国指南Ⅰ类推荐组1 580例,指南Ⅱa类推荐组77例。2001年、2006年和2011年,指南Ⅰ类推荐组患者ACEI/ARB加权使用率分别为61.0%、65.5%和66.5%(趋势P值=0.15);指南Ⅱa类推荐组患者为57.2%、55.6%和58.4%(趋势P值=0.89)。两组人群随时间变化ACEI/ARB使用率均无明显改变。在三个研究年份中,ACEI使用率均显著高于ARB。多因素分析显示,合并高血压[比值比(OR)=1.73,95%可信区间(CI):1.28~2.35]、心力衰竭(OR=1.92,95%CI:1.40~2.62)的患者更倾向于使用ACEI/ARB;与入院时收缩压90~139 mm Hg(1 mm Hg=0.133 k Pa)相比,收缩压≥140 mm Hg(OR=1.90,95%CI:1.40~2.62)的患者更容易接受ACEI/ARB,相反,收缩压90 mm Hg(OR=0.42,95%CI:0.22~0.80)的患者较少使用ACEI/ARB。结论:2001年~2011年间,我国中部农村地区的AMI患者中ACEI/ARB使用存在明显不足,且随时间推进无明显改善。ACEI/ARB在此类患者中的应用亟待改善,以缩小临床实践与循证医学证据和指南推荐之间的差距,提高医疗服务质量,改善患者预后。
[Abstract]:Objective: to investigate the use of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with acute myocardial infarction (AMI) in rural areas of central China from 2001 to 2011 and to explore the influencing factors. Methods: the data of China PEACE retrospective AMI study were used to evaluate the medical outcome and clinical transformation of coronary heart disease. The clinical information of representative rural AMI patients in 2001, 2006 and 2011 were obtained by two-stage random sampling. In order to assess the use of ACEI/ARB, patients were classified according to the Chinese guidelines into guidelines I recommendation group [including (STEMI) with ST segment elevation myocardial infarction and with heart failure, Left ventricular ejection fraction (LVEF), non-ST segment elevation myocardial infarction (NSTEMI) in hypertension or diabetes mellitus] and guidance II-a recommendation group (NSTEMI). Without recommendation I) In order to estimate the utilization rate and change trend of ACEI/ARB in three years, the data of each year were weighted to represent the whole situation of rural areas in central China. The factors influencing its use were analyzed by using binary Logistic regression method. Results one hundred and thirty-five central rural hospitals participated in the study, and 1 657 AMI cases were selected. Of them, 1 580 cases were classified as Chinese guidelines I recommendation group, 77 cases as guideline II a recommendation group, 2001, 2006 and 2011, respectively. The weighted utilization rate of ACEI/ARB in group I was 65.5% and 66.5% (trend P = 0.15), and that in group 鈪，

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