摘要
目的:比较我国省级、市级及县级三个级别医院针对ST段抬高型急性心肌梗死(STEMI)患者进行再灌注治疗和住院期间二级预防药物的使用情况。方法:中国急性心肌梗死注册(CAMI)研究在2013-01-01至2014-09-30期间共登记覆盖全国31个省市、自治区和直辖市107家医院收治的18967例在发病7天内的STEMI患者,其中223例患者因住院结局等关键数据缺失而被排除,分析省、市和县级三个级别医院收治患者的人口统计学信息、再灌注治疗[包括急诊冠状动脉介入治疗(PCI)和溶栓治疗]和二级预防用药[包括阿司匹林、P2Y12抑制剂、他汀类药物、β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)]的使用情况。结果:在分析的18744例STEMI患者中,9885例(52.7%)接受了再灌注治疗,其中8038例(42.9%)接受了急诊PCI,1847例(9.9%)接受了溶栓治疗。省级医院再灌注治疗率明显高于地市级医院和县级医院,分别为4041例(61.8%)、4728例(49.1%)和1116例(43.2%),差异有统计学意义(P<0.001);三个级别医院的再灌注治疗方式也存在明显差别,省级医院:急诊PCI 3840例(58.7%),溶栓201例(3.1%);市级医院:急诊PCI 3753例(39.0%),溶栓975例(10.1%);县级医院:急诊PCI 445例(17.2%),溶栓671例(26.0%)。发病12小时内到达医院的12502例患者中有8856例(70.8%)接受再灌注治疗,其中急诊PCI 7089例(56.7%),溶栓1746例(14.1%),省级医院3537例(80.0%),市级医院4274例(67.5%),县级医院1045例(59.8%),三个级别的医院依然差别明显(P<0.001)。在住院期间有16575例(90.9%)使用他汀、17963例(96.8%)使用阿司匹林,17922例(96.5%)例应用P2Y12抑制剂,12657例(68.2%)使用β受体阻滞剂,10541例(56.8%)使用ACEI/ARB。三个级别医院在应用上述几种二级预防用药比例相似。结论:CAMI研究中,在发病12小时内到达医院的患者中,有70.8%接受再灌注治疗。县级医院的再灌注治疗率明显较低。三个级
Objective：To investigate reperfusion and secondary preventive drug therapy for ST-segment elevation myocardial infarction（STEMI） patients in provincial,city and county levels hospitals of China.Methods：A total of 18,967 STEMI patients within 7 days of symptom onset from 2013-01-01 to 2014-09-30 were enrolled by China acute myocardial infarction（CAMI） registry study group from 107 hospitals covering 31 provinces/autonomous regions,cities and counties in China;223 patients were excluded for key information missing.Demographic data,reperfusion as primary percutaneous coronary intervention（p PCI）,thrombolytic therapy（TT） and secondary preventive drug therapy as aspirin,P2Y12 inhibitors,statins,β-blockers,angiotensin-converting enzyme inhibitor（ACEI）/angiotensin receptor antagonist（ARB） were analyzed and compared among 3 levels of hospitals.Results：There were 9,885/18,744（52.7%） patients received reperfusion including 8,038（42.9%） pP CI and 1,847（9.9%） TT.Reperfusion rate in provincial hospital（61.8%,4041/6537） was higher than city hospital（49.1%,4728/9625） and county hospital（43.2%,1116/2582）,P0.001;reperfusion type was distinctive among 3 levels of hospitals,for provincial hospital：pP CI was performed in 3,840（58.7%）,TT in 201（3.07%） patients;for city hospital：pP CI in 3,753（39.0%）,TT in 975（10.1%） patients;for county hospital：p PCI in 445（17.2%）,TT in 671（26.0%） patients.12,502 patients arrived hospital within 12 h of symptom onset and 8,835（70.8%） of them received reperfusion including 7089（56.7%） patients with pP CI and 1,746（14.1%） with TT.3537（80%） patients received reperfusion in provincial hospital,4272（67.5%） in city hospital and 1045（59.8%） in county hospital,P0.001.The in-hospital application of statins was in 16,575（90.9%） patients,aspirin was 17,963（96.8%）,P2Y12 inhibitors was 17,922（96.5%）,β-blockers was 12,657（68.2%） and ACEI/ARB was 10,541（56.8%） respectively;the therapeuti
出处
《中国循环杂志》
CSCD
北大核心
2017年第1期12-16,共5页
Chinese Circulation Journal
基金
中国医学科学院医学与健康科技创新工程(2016-I2M-1-009)
国家"十二.五"科技支撑计划课题:心血管疾病及其危险因素监测
预防和治疗关键技术研究(2011BAI11B02)
国家卫生和计划生育委员会公益性行业科研专项(201402001)
关键词
心肌梗死
心肌再灌注
血栓溶解疗法
血管成形术
经腔
经皮冠状动脉
Myocardial infarction
Myocardial Reperfusion
Thrombolytic therapy
Angioplasty
transluminal
percutaneous coronary
