急性冠状动脉综合征10年间临床回顾性分析  

Retrospective analysis of hospitalized patients with acute coronary syndromes in 10 years

作　　者：郑刚[1] 刘兆昶[2] 姜义存[1] 杨顺来[1] 黄自平[1] 张德铭[1] 

机构地区：[1]天津市第三医院心内科,天津300250 [2]天津市老年病研究所临床心血管病研究室,天津300250

出　　处：《中国心血管杂志》2006年第6期422-424,435,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的了解我院急性冠状动脉综合征（ACS）住院患者在ACS治疗指南公布前后再灌注和药物治疗10年间的差异及对ACS患者住院病死率的影响。方法冠心病病房收治的950例ACS患者，分成指南公布前组（1995～1999年、A组）和指南公布后组（2000-2005年、B组）。分别对两组住院病历进行回顾性分析及比较。结果①共有950例患者入选，其中男性692例，ST段抬高心肌梗死（STEMI）患者441例，非ST段抬高心肌梗死（NSTEMI）患者162例，不稳定型心绞痛（UAP）患者347例，两组平均年龄分别为（66．4±10．3）岁和（67．2±10．5）岁。B组较A组住院时间（12．8±4．6）d比（20．5±8．5）d缩短（P均〈0．001）。②近年来肝素、β受体阻滞剂、血管紧张素转化酶抑制剂（ACEI）、他汀类调脂药和氯吡格雷的使用率明显升高（P均〈0．001）；阿司匹林和硝酸酯类药物临床使用率较高且无明显变化（P均〉0．05）。③ACS患者接受再灌注治疗方式发生改变，溶栓治疗有下降的趋势（P〉0．05），而经皮冠状动脉介入治疗（PCI）明显升高（P〈0．001）。住院病死率明显降低（P〈0．05）。结论自ACS治疗指南公布后，住院的ACS患者肝素、B受体阻滞剂、ACEI、他汀类调脂药和氯吡格雷的使用率明显升高，溶栓治疗有下降的趋势，而PCI明显升高。住院病死率有降低趋势（P〉0．05），但距指南仍有较大差距。Objective To evaluate the difference between reperfusion and medicine therapy and to analysis the influence of guiddines on mortality before and after announcement of clinical therapy guidelines on acute coronary syndromes（ACS）. Methods All patients with acute coronary syndromes were enrolled the study and divided into groups A, admitted hospital in 1995 - 1999, and groups B, admitted hospital in 2000-2005. Results （ 1 ） 950 patients with ACS（ 692 male and 258 female） were enrolled. ST segment elevation myocardial infarction（ STEMI ）, non ST segment elevation myocardial infarction （NSTEMI） and unstable angina（UA） was diagnosed in 441,162 and 347 patients. Average age and hospitalization duration were （ 66.4 ± 10.3 ） years old and （ 20.5 ± 8.5 ） days in groups A and （ 67.2 ± 10.5 ） years old and （ 12.8 ± 4.6 ） days. The duration of hospitalization in groups B was shorter than that in groups A. （2）The use of heparin,β blocker and angiotensin conversion enzyme inhibition （ACEI）, statin and clopidogrd were increased in group B than group A （all P 〈 0. 001 ）. The use of ASA and nitride have no significantly differences between in groups A and in groups B （ all P 〉0.05 ） in recent years. （3）Reperfusion therapy have been changed, Thrombolytic therapy tend to be decreased（P 〉 0.05）, but the PCI obviously increased （ P 〈 0. 001 ）. And mortality of hospitalization was declinedf （ P 〈 0.05 ）. Conclusions This study show that after announcement of clinical therapy guidelines of ACS, the using of heparin, β-blocker and ACEI, statin and elopidogrel to obvious go up and thrombolysis therapy was decreased relatively. But the PCI significantly in increased and mortality of hospitalization was lowered in hospitalization in ACS patients, of course, flora was big difference between clinical therapy guiddines of ACS. and present clinical practice.

关 键 词：急性冠状动脉综合征 药物治疗 病死率 

分 类 号：R541.4[医药卫生—心血管疾病] R542.22[医药卫生—内科学]