急性心肌梗死患者神经内分泌抑制药物应用调查与分析  

Investigation and Analysis of the Application of Neuroendocrine Inhibitors on Patients With Acute Myocardial Infarction

作　　者：李静[1] 蒋林轩 赵敏[1] 

机构地区：[1]南京医科大学附属无锡市人民医院药剂科,江苏省无锡市214023 [2]南京医科大学康达学院

出　　处：《中国全科医学》2015年第20期2451-2453,2457,共4页Chinese General Practice

摘　　要：目的分析急性心肌梗死（AMI）患者神经内分泌抑制药物的使用情况,为临床合理用药提供依据。方法选取2013年1月—2014年5月于南京医科大学附属无锡市人民医院心血管内科治疗的AMI患者293例为研究对象,收集患者基本情况、药物使用情况、体征及实验室检查结果。结果血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）实际用药患者占推荐用药的67.0%（136/203）,β受体阻滞剂（β-BK）实际用药患者占推荐用药的86.8%（197/227）,心功能Killip分级各级患者醛固酮受体拮抗剂（MRA）实际用药人数均超过推荐用药人数。53.6%（157/293）的患者接受联合神经内分泌抑制治疗,其中ACEI/ARB＋β-BK＋MRA联合用药18例（6.1%）,ACEI/ARB＋β-BK联合用药88例（30.0%）,ACEI/ARB＋MRA联合用药17例（5.9%）,β-BK＋MRA联合用药34例（11.6%）。心功能Killip分级Ⅰ~Ⅳ级患者同时使用ACEI/ARB和β-BK的例数依次为89例（38.5%）、11例（32.3%）、5例（26.4%）及1例（11.1%）。136例使用ACEI/ARB患者中剂量达标113例（83.1%）,其中达目标剂量83例,达最大耐受量30例。197例使用β-BK患者中剂量达标127例（64.5%）,其中达目标剂量22例,达最大耐受量105例。97例使用MRA患者均达目标剂量。结论本院急性心肌梗死患者神经内分泌抑制药物中ACEI/ARB、β-BK使用率及剂量达标率均偏低,而MRA使用率过高,与指南存在一定差距。Objective To investigate the utilization status of neuroendocrine inhibitors on patients with acute myocardial infarction（AMI） and to provide references for clinical rational drug use.Methods We enrolled 293 AMI patients who received treatment in the Department of Cardiology,Wuxi People＇ s Hospital Affiliated to Nanjing Medical University from January 2013 to May 2014.The basic data,drug use,physical signs and laboratory examination results were collected.Results The patients who received ACEI/ARB accounted for 67.0%（136/203） of those recommended,the patients who receivedβ-BK accounted for 86.8%（197/227） of those recommended,and the patients who received MRA were more than those recommended among every Killip level.Of all the subjects,53.6%（157/293） were given combined neuroendocrine inhibitors,among which 18（6.1%） were given ACEI/ARB ＋ β-BK ＋ MRA,88（30.0%） were given ACEI/ARB ＋ β-BK,17（5.9%） were given ACEI/ARB ＋ MRA,and 34（11.6%） were given β-BK ＋ MRA.Among the subjects of Killip I to IV,the number of subjects who used ACEI/ARB and β-BK was 89（38.5%）,11（32.3%）,5（26.4%） and 1（11.1%）respectively.Among the 136 subjects who took ACEI/ARB,113（83.1%） subjects reached the standard dose,inclding 83 who reached target dose and 30 who reached the maximum tolerance dose.Among the 197 subjects who took β-BK,127（64.5%）reached the standard dose,inclding 22 who reached target dose and 105 who reached the maximum tolerance dose.The 97 subjects who took MRA were all given target dose.Conclusion Among the neuroendocrine inhibitors used by our hospital,the usage rate and the standard dose reaching rate of ACEI/ARB and β-BK are low,while the usage rate of MRA is excessively high.The case is not corresponded with the guideline.

关 键 词：心肌梗死 血管紧张素转换酶抑制剂 血管紧张素受体拮抗剂 肾上腺素能Β受体阻滞剂 醛固酮受体拮抗剂 

分 类 号：R542.22[医药卫生—心血管疾病]