中国急性冠状动脉综合征诊疗模式的现状调查  

Survey of hospital management of acute coronary syndrome in China

作　　者：庞鑫[1] 李静[1] 李希[2] 魏小帅[1] 张海波[1] 张丹[1] 冯芳[1] 刘佳敏[1] 高岩[1] 乌汉毕力格[1] 李丽[1] 葛蕾[1] 陈怡平[3] 陈铮鸣[3] 蒋立新[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院中国牛津国际医学研究中心,北京100037 [2]北京大学医学部公共卫生学院流行病与卫生统计学系 [3]英国牛津 牛津大学临床试验与流行病学研究中心

出　　处：《临床心血管病杂志》2011年第7期503-506,共4页Journal of Clinical Cardiology

摘　　要：目的:了解中国心血管病医生对急性冠状动脉综合征(ACS)诊疗的观点,评估目前中国ACS急性期诊治及二级预防治疗的模式。方法:在全国范围内选取代表性医院,于2010-04-2010-08期间向各医院负责ACS诊疗的科室的负责医生邮寄统一的调查问卷,了解其对ACS急性期及二级预防诊疗的观点,并进行描述和统计分析。结果:共发放问卷1 389份,回收1 009份(73%)。调查显示,肌酸激酶同工酶和(或)肌钙蛋白是绝大多数被调查医生选用的急性期心肌损伤标记物。对急性ST段抬高型心肌梗死的再灌注治疗,三级医院中51%首选急诊经皮冠状动脉介入术,而二级医院中82%首选静脉溶栓治疗。87%以上的医生认为抗血小板治疗、抗凝治疗、他汀类药物、β-受体阻滞剂、血管紧张素转化酶抑制剂和硝酸酯类药物是ACS急性期的常规治疗药物。一些指南不推荐的药物(如钙离子拮抗剂、硫酸镁制剂及极化液)仍被部分医生常规使用。在二级预防方面,85%以上的医生认为应给予患者抗血小板治疗、他汀类药物、β-受体阻滞剂和血管紧张素转化酶抑制剂。结论:目前中国大中型医院的心血管病医生对于ACS急性期诊治及二级预防治疗模式的观点与指南基本吻合,但仍有待改进之处。Objective：To investigate the current opinions of Chinese cardiologists about acute coronary syndrome（ACS） management and to evaluate the model of ACS management in China.Method：We selected representative hospitals in China.From April to August in 2010,we posted questionnaire and collected information from chief cardiologists in each hospital about their opinions on the usual diagnosis and treatment of ACS.The data collected were described and analyzed.Result：We distributed 1 389 questionnaires,and got 1 009（73%） completed.Creatine kinase-MB and troponins were widely used as the cardiac biomarkers in ACS diagnosis.For the reperfusion therapy of patients with ST-segment elevation myocardial infarction,51% of cardiologists from tertiary hospitals would routinely use primary percutaneous coronary intervention.And 82% from secondary hospitals would mainly use intravenous thrombolysis.Early hospital treatments reported to be routinely used for most ACS patients included antiplatelet therapy（97% of cardiologists）,anticoagulant therapy（94%）,statin（96%）,beta-blocker（87%）,angiotensin-converting enzyme（ACE） inhibitor（87%） and nitrates（87%）.Although calcium channel blocker,magnesium and glucose-insulin-potassium were not recommended by current guidelines,some cardiologists still use them routinely.Long-term antiplatelet therapy（96% of cardiologists）,statin（95%）,beta-blocker（90%） and ACE inhibitor（85%） were reported to be routinely used as secondary prevention for ACS patients.Conclusion：The current management model of ACS in China generally adheres to the latest guidelines although further improvement is required.

关 键 词：急性冠状动脉综合征 诊疗观点 现状调查 

分 类 号：R541.4[医药卫生—心血管疾病]