临床指南公布对急性心肌梗死患者早期住院治疗及预后影响  

Effect of the issue of Chinese guideline on early hospital management and prognosis of patients with acute myocardial infarction

作　　者：王静[1] 郑刚[1] 张德铭[1] 黄自平[1] 齐惠英[1] 

机构地区：[1]天津市第三医院心内科,天津300250

出　　处：《中国心血管杂志》2007年第2期108-110,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的评价我国2001年12月中华医学会心血管病学分会等制订的急性心肌梗死(AMI)诊断和治疗指南(简称2001年指南)公布对AMI患者住院早期治疗及预后的影响.方法回顾性研究我院1998-01-2000-12、2003-01-2005-12两个不同时期住院的所有AMI病例,依据我国指南公布时间将患者分为两组,A组(1998-01-2000-12:指南公布前组)、B组(2003-01-2005-12:指南公布后组).结果共有780例患者入选,A组347例,B组433例.指南公布前后两组AMI患者的临床特征比较无统计学差异(P均>0.05).指南公布后患者早期再灌注治疗率(66.42%vs48.43%,P<0.001)和住院期间β受体阻滞剂(BB)(40.92%vs75.29%,P<0.001)、血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻断剂(ARB)类药物(40.34%vs72.98%,P<0.001)、他汀类药物(26.22%vs67.90%,P<0.001)和肝素(59.94%vs88.91%,P<0.05)等药物的使用率均较指南发布前增加,差异有统计学意义;硝酸酯类和抗血小板药物的使用率与指南发布前比较也有所增加,但差异未达统计学意义(P均>0.05);指南公布后住院期间梗死后心绞痛、心力衰竭、心室颤动发生率和病死率较发布前明显降低(分别为27.71%vs41.50%,P<0.001;17.55%vs31.12%,P<0.001;6.00%vs11.82%,P<0.05;6.47%vs11.82%,P<0.05);心源性休克、梗死延展或再梗死也有所降低,但未达显著统计学差异(6.24%vs8.65%,P>0.05;1.39%vs2.88%,P>0.05).结论我国急性心肌梗死诊断和治疗指南对我院AMI患者住院早期治疗影响显著,治疗较前趋于规范化,并显著降低了住院期间一些并发症的发生率和病死率.Objective To evaluate the effect of the issue of Chinese guideline （December 2001） on early hospital management and prognosis of patients with acute myocardial infarction（AMI）. Methods A retrospective study was carried out in our hospitalized patients with AMI. Patients were divided into two groups according to the Chinese guideline issued time （group A ： from January 1998 to December 2000 and group B ： from January 2003 to December 2005）. Results There were 780 patients enrolled in our study. Reperfusion therapy was performed in 48.43% of patients in group A, and 66.42% in group B （P〈0. 05）; Beta blockers （40.92% vs 75.29%, P〈 0. 001）, ACE inhibltors and/or angiotensin receptor blockers 40.34% vs 72.98%, P〈0. 001）, statins-agents （26.22% vs 67.90%, P〈0. 001） and heparin （59.94% vs 88.91%, P〈0.05） were taken less extensively in group A than in group B; there was no significant difference in the use of nitrates and antiplatelet drugs between groups A and 13. After the guideline issued, the incidence of angina pectoris （27.71% vs 41.50%, P〈0. 001）, heart failure （17.55% vs 31.12%, P〈0. 001）, ventrlcular fibrillation （6.00% vs 11.82%, P〈0. 05 ） and hospital mortality （6.47% vs 11.82%, P〈0.05） were lower in the group B than in the group A ; there was no significant difference in the incidence of cardiogenic shock and infarction extension/reinfarction between teh 2 groups. Conclusions The Chinese guideline issued on December 2001 has great effects on the management and prognosis of patients with AMI in our hospital. After the guideline was issued, the management became more standardized and the incidences of complications and hospital mortality decreased than before.

关 键 词：指南 急性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病] R45[医药卫生—内科学]