摘要
目的了解甘宁青新四省区急性心肌梗死（AMI）患者中血管紧张素转化酶抑制剂和血管紧张素受体阻滞剂（ACEI／ARB）的使用情况，并探讨其影响因素。方法研究数据来源于一项覆盖全国31个省的冠心病医疗结果评价研究——China PEACE回顾性AMI研究，本研究使用甘宁青新四省区8家协作医院（其中三级医院2家、二级医院6家）数据进行分析。通过调查甘宁青新四省区8家协作医院2001、2006、2011三个特定年份的研究病历，分析ACEI／ARB的使用情况，并采用二元logistic回归方法探讨其使用的影响因素。结果共人选311例患者，其中中国指南I类推荐组300例，指南Ⅱa类推荐组11例。指南Ⅰ类推荐患者2001年、2006年和2011年ACEI／ARB使用率分别为69．57％，82．19％和60．77％（P=0．033），指南1Ia类推荐患者的ACEI／ARB使用率分别为40％，0％和60％（P=0．525）。不同年份ACEI／ARB使用率在I类推荐患者中差异有统计学意义，而在IIa类推荐患者中差异无统计学意义。在3个研究年份中，ACEIs使用率均显著高于ARBs。多因素分析显示吸烟、卒中、高血压、心力衰竭和收缩压水平是影响ACEI／ARB使用的独立相关因素，即吸烟（OR=2．0，95％CI：1．2～3．6）、合并高血压（OR=2．3，95％CI：1．3～4．1）、心力衰竭（OR=3．1，95％CI：1．7～5．8）的患者更容易接受ACEI／ARB类药物，而有卒中史（OR=0．3，95％CI：0．1～0．8）、入院时收缩压〈90mmHg（1mmHg=0．133kPa）（OR=0．1，95％CI：0～0．5）的患者使用ACEI／ARB类药物比例较低。结论甘宁青新欠发达地区，急性心肌梗死患者住院期间规范服用ACEI／ARB总体比例仍较低，ACEI／ARB使用率并未随着医疗条件的进步、经济的发展、信息的普及而增高，尤其是合并卒中史、低血压患者，而合并高血压、心力衰竭、吸烟者更易接受ACEI／ARB类药物，主要�
Objective To investigate the rate of employing angiotensin converting enzyme inhibitors/angiotensin receptor blockers （ACEI/ARB） therapy in patients with acute myocardial infarction （AMI） in Gansu, Ningxia, Qinghai and Xinjiang provinces from 2001 to 2011, in order to determine the factors affecting the use of ACEI/ARB. Methods The original data of this study were obtained from the China PEACE, a national retrospective study of AMI to evaluate clinical outcome of coronary heart disease from 31 provinces. A part of these data was selected from 8 cooperative hospitals （2 hospitals were tertiary class and 6 hospitals were secondary class ） from Gansu, Ningxia, Qinghai and, Xinjiang provinces for further analyses. The clinical data of AMI patients in 2001, 2006 and 2011 were collected to analyze the use of ACEI/ARB therapy in each of these years. Binary logistic regression analysis was used to identify factors influencing the use of ACEI/ARB. Results Of 311 eligible patients included, 300 were categorized into Class Ⅰ AMI and 11 into Class Ⅱ a AMI according to Chinese guidelines. From 2001 to 2011, there was significant change in the use of ACEI/ARB in term of percentage in patients with Class [ AMI （69. 57% , 82. 19% and 60. 77%, P = 0. 033）, but such change did not occur in patients with Class Ⅱ a AMI （40%, 0% and 60% , P = 0. 525）. Among three specific years, the percentage of ACEIs employed was noticeably higher than that of ARBs. Binary logistic regression analysis showed that patients with hypertension OR = 2.3, 95%CI： 1.3-4.1）, heart failure （OR=1.95, 95%CI： 1.7-5.8）, smoking indulgence OR= 2. 0, 95% CI：1. 2 -3.6） were more likely to be treated with ACEI/ARB, and patients with prior stroke （OR=0.3, 95%CI：0.1 -0.8） , systolic blood pressure〈90 mmHg （OR=0.1, 95%CI： 0-0.5） were less likely to be treated with ACEI/ARB. Conclusions In underdeveloped areas such as Gansu, Ningxia, Qinghai and Xinjiang provinces, the overall proportion of rational and necessary use
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第9期1065-1070,共6页
Chinese Journal of Emergency Medicine
基金
冠心病医疗结果评价研究和临床转化研究（201202025）
国家科技支撑计划项目“冠心病医疗质量改善研究”（2013BAI09B01）
关键词
急性心肌梗死
血管紧张素转化酶抑制剂
血管紧张素受体阻滞剂
医疗质量
Acute myocardial infarction
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Quality of medical care
