中国西部农村急性心肌梗死早期β受体阻滞剂使用十年趋势

发布时间：2018-05-11 01:22

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~2011年间中国西部农村急性心肌梗死(AMI)早期(入院24h内)β受体阻滞剂的使用情况。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西部农村协作医院;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。比较西部农村AMI患者入院24h内β受体阻滞剂的使用变化趋势,采用多因素模型分析其使用的影响因素。结果:抽取35家医院(其中32家最终参加),从抽样获取的AMI病历中排除不适宜评价β受体阻滞剂使用的人群,最终获得无β受体阻滞剂禁忌证的AMI病历486例,其中247例适宜早期使用β受体阻滞剂,239例存在高休克风险。入院24h内β受体阻滞剂使用率于2001年、2006年和2011年在适宜人群中分别为19.06%、54.30%和56.20%(趋势P=0.0020),在休克高风险人群中分别为31.53%、59.49%和69.62%(趋势P=0.0001)。适宜人群中,高血压病史[比值比(OR)=1.87,95%可信区间(CI):1.06~3.29],吸烟(OR=1.97,95%CI:1.11~3.48),或在2006年(OR=2.93,95%CI:1.22~7.03)、2011年(OR=4.67,95%CI:2.06~10.59)入院与入院24h内β受体阻滞剂使用率高相关。结论:我国西部农村地区AMI患者中,入院24h内β受体阻滞剂的使用自2001年至2011年呈上升趋势,但仍与指南推荐存在较大差异,提高其使用规范性有助于改善AMI诊疗质量及患者预后。
[Abstract]:Objective: to evaluate the use of 尾 -blockers in the early stage (24 h after admission) of acute myocardial infarction (AMI) in rural areas of western China from 2001 to 2011. Methods: two-stage random sampling design was used. In the first stage, the western rural cooperative hospital is determined by simple random sampling. In the second stage, three specific years, 2001, 2006 and 2011, are selected, and the systematic random sampling method is adopted in the collaborative hospital to extract and study the medical records. The central medical records were extracted. To compare the change trend of 尾 -blocker use in AMI patients in western rural areas within 24 hours after admission to hospital, and to analyze the influencing factors of the use of 尾 -blockers by multivariate model. Results: a total of 35 hospitals (32 of them) were selected to participate in the study. From the selected AMI medical records, 486cases of AMI patients without contraindications of 尾 -blockers were excluded from the sample of patients who were not suitable to evaluate the use of 尾 -blockers. The risk of shock was high in 247 patients who were suitable for early use of 尾 -blocker. The utilization rate of 尾 -blocker was 19.06% and 56.20% in the suitable population in 2006 and 2011 (trend P0. 0020), and in the high risk group of shock, it was 31. 53% and 69. 62% (trend P = 0. 0001). In the suitable population, the history of hypertension [the ratio was 1.8795% CI = 1.8795% CI: 1.063.29], smoking was 1.9795 CI: 1.113.48m, or in 2006 it was 2.9395 CI: 1.227.03, in 2011 OR4.6795CI2.06HZ 10.59) there was a high correlation between the use of 尾 -blockers in 24 hours. Conclusion: the use of 尾 -blockers in AMI patients in rural areas of western China increased from 2001 to 2011 within 24 hours of admission, but there is still a significant difference from the recommendations of the guidelines. To improve the quality of diagnosis and treatment and the prognosis of patients with AMI.
【作者单位】：北京大学人民医院心血管内科急性心肌梗死早期预警和干预北京市重点实验室;北京协和医学院中国医学科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心血管疾病国家重点实验室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) 高等学校学科创新引智计划(B16005)
【分类号】：R542.22

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