中国东部城市急性心肌梗死早期β受体阻滞剂使用十年趋势

发布时间：2018-05-06 05:27

本文选题：心肌梗死 + β受体阻滞剂　；参考：《中国循环杂志》2017年04期

【摘要】：目的:评价2001年至2011年间中国东部城市急性心肌梗死(AMI)早期(入院24h内)β受体阻滞剂在适宜人群中的使用情况。方法:采用两阶段随机抽样设计。第一阶段,通过简单随机抽样确定东部城市协作医院。第二阶段,选取2001年、2006年和2011年三个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,进行中心性病历信息提取。采用加权计算方法,评价中国东部城市AMI患者早期β受体阻滞剂使用变化趋势及影响因素。结果:抽取35家医院,最终32家参加,从抽样获取的AMI病历中排除不适宜评价早期使用β受体阻滞剂患者,最终获得1399例β受体阻滞剂早期使用绝对适宜人群。在入组患者中,2001年、2006年和2011年早期β受体阻滞剂加权使用率分别为64.7%、69.7%和60.9%(P=0.0447)。入院时有胸部不适症状[比值比(OR)=2.22,95%可信区间(CI):1.19~4.13],收缩压偏高(OR=1.40,95%CI:1.11~1.77)或心率偏快(OR=2.01,95%CI:1.58~2.55)的患者更倾向于早期服用β受体阻滞剂;反之,急性ST段抬高型心肌梗死(STEMI)患者比非急性ST段抬高型心肌梗死(NSTEMI)患者,更少接受此早期治疗(OR=0.55,95%CI:0.37~0.81)。结论:中国东部城市地区,AMI早期适宜使用β受体阻滞剂患者中,2001年至2011年整体使用率不足,且无改善趋势,这可能与医生对于循证医学证据及指南推荐的理解不到位、过度担心药物副作用有关。若能充分利用β受体阻滞剂这类相对便宜且疗效明确的治疗措施,将有利于资源最大化利用,进一步改善患者预后。
[Abstract]:Aim: to evaluate the use of 尾 -blockers in the early stage of acute myocardial infarction (AMI) from 2001 to 2011 (within 24 hours of admission) in the suitable population. Methods: two-stage random sampling design was used. In the first stage, the eastern city cooperation hospital was determined by simple random sampling. In the second stage, three specific years, 2001, 2006 and 2011, were selected to extract the central medical records in collaborative hospitals by using systematic random sampling method. To evaluate the trend and influencing factors of early 尾 -blocker use in urban AMI patients in eastern China, a weighted calculation method was used. Results: 35 hospitals were selected, 32 of them participated in the study. It was excluded from the AMI medical records that it was not suitable to evaluate the early use of 尾 -blocker. Finally, 1399 cases of early use of 尾 -blocker were found to be absolutely suitable for the population. In 2001, 2006 and 2011, the weighted utilization rate of 尾 -blockers was 69.7% and 60.9% in 2001, 2006 and 2011, respectively. Patients with chest discomfort at admission [/ R = 2.22 / 95% CI: 1.194.13], high systolic blood pressure = 1.4095 / CI: 1.111.77) or heart rate or2.01v / 95CI1.58C / 2.55) were more likely to take beta blockers at an early stage; conversely, patients with high systolic blood pressure had a higher risk of taking beta-blockers at an early stage; conversely, patients with high systolic blood pressure had a higher risk of taking beta-blockers at an early stage. Patients with acute ST-segment elevation myocardial infarction (STEMI) received less early treatment than those with non-acute ST-segment elevation myocardial infarction (NSTEMI). Conclusion: in the early stage of AMI in urban areas of eastern China, the overall use of 尾 -blocker is insufficient from 2001 to 2011, and there is no improvement trend, which may not be well understood by doctors about the evidence and guidelines of evidence-based medicine. Excessive concern about side effects of drugs. If we can make full use of beta-blockers such as relatively cheap and definite therapeutic measures, it will be beneficial to maximize the utilization of resources and further improve the prognosis of 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国家心血管病临床研究中心中国牛津国际医学研究中心;
【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(201502009) 国家科技部科技支撑计划(2013BAI09B01,2015BAI12B01,2015BAI12B02)
【分类号】：R542.22

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