冠心病血运重建术后患者药物治疗现状  

Medical therapy in revascularized coronary artery disease patients

作　　者：刘小慧[1] 杜昕[1] 康俊萍[1] 吕强[1] 张强[1] 吕树铮[1] 陈方[1] 马长生[1] 

机构地区：[1]首都医科大学北京安贞医院心内科,100029

出　　处：《中华医学杂志》2008年第4期236-239,共4页National Medical Journal of China

基　　金：国家重点基础研究发展规划基金资助项目（2003CB517103）

摘　　要：目的了解我院冠心病血运重建患者二级预防的现状。方法入选药物洗脱支架对血运重建的影响研究（DESIRE）数据库中2003年7月至2004年6月接受血运重建的冠心病且资料完整的患者2048例，平均年龄（60．1±10．4）岁，男1580例。记录经皮冠状动脉成形术（PCI）或冠状动脉搭桥术（CABG）患者住院和随访期间服用阿司匹林（ASA）、B受体阻滞剂（BB）、他汀类药物、血管紧张素转换酶抑制剂（ACEI）等药物的情况。随访中记录主要心血管不良事件（死亡、AMI、再次血运重建、脑卒中）发生情况。平均随访（587±127）d。结果住院期间ASA、BB、他汀类药物和ACEI的使用率分别为1923例（93．9％）、1821例（88．9％）、1387例（67．7％）和1288例（62．9％）。ASA、BB、他汀类药物3种药物合用者1206例（58．9％），4种药物合用者813例（39．7％）。PCI组二级预防常用药物的使用率显著高于CABG组（P〈0．001）。随访期间药物的使用率均显著低于住院期间（P〈0．001），ASA、BB、他汀类药物及ACEI的使用率分别为1860例（90．8％）、1175例（57．4％）、881例（43．0％）和501例（24．5％），其中CABG组使用率显著低于PCI组（P〈0．001）。随访药物使用率有区域差异，北京地区患者药物使用率显著高于其他地区患者（P〈0．001）。结论冠心病患者接受血运重建后，住院期间二级预防药物治疗使用率均较高。随访期间药物使用率显著降低，特别是接受CABG治疗和北京以外地区患者，应加强冠心病患者二级预防药物的治疗。Objective To evaluate the status of medical therapy in the revascularized coronary artery disease （CAD） patients treated in Anzhen Hospital. Methods 2048 CAD patients who received revascularization during July 2003 to June 2004 were registered in DESIRE database. The methods of revascularization [ percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG） ] and use of medicines [ aspirin, [3blocker （ BB）, statins, angiotension converting enzyme inhibitor （ACEI） etc ] during hospitalization and during the follow-up were recorded. The patients were followed up for a mean time of 587 ± 127 days. Results The prescription rates of aspirin, BB, statins, and ACEI were 93. 9%, 88.9%, 67.7%, and 62.9% respectively. 58.9% of the patients used combined aspirin, BB, and statins; and 39.7% of the patients used combined aspirin, BB, statins, and ACEI. The prescription rates of these drugs was all significantly higher in the PCI group than in the CABG group（ all P 〈 0.001 ）. The prescription rates of these drugs during follow-up were 90. 8%, 57.4%, 43.0%, and 24. 5% respectively, all significantly lower than those during hospitalization （ all P 〈 0. 001 ）. The prescription rates of these medicines were all significantly higher in Beijing compared with in the areas other than Beijing （ all P 〈 0. 001 ）. Conclusion The CAD patients who received revascularization show a high proportion of using secondary prevention drugs during hospitalization, and the prescription rates of these drugs decrease significantly during follow-up, especially in those who received CABG and who live outside Beijing.

关 键 词：冠心病 二级预防 药物 

分 类 号：R686[医药卫生—骨科学]