中国西部农村急性心肌梗死早期β受体阻滞剂使用十年趋势  

10-year Trend of Early Beta Receptor Blocker Application for Acute Myocardial Infarction Patients in Western Rural China

作　　者：蒋子涵[1] 张海波[2] 李静[2] 白雪珂 陈红[1] 

机构地区：[1]北京大学人民医院 心血管内科 急性心肌梗死早期预警和干预北京市重点实验室,北京市100044 [2]北京协和医学院中国医学科学院 国家心血管病中心 阜外医院 国家心血管病临床研究中心 心血管疾病国家重点实验室 中国牛津国际医学研究中心

出　　处：《中国循环杂志》2017年第4期338-342,共5页Chinese Circulation Journal

基　　金：国家卫生和计划生育委员会卫生公益性行业科研专项(201502009);国家科技部科技支撑计划(2013BAI09B01,2015BAI12B01,2015BAI12B02);高等学校学科创新引智计划(B16005)

摘　　要：目的:评价2001年~2011年间中国西部农村急性心肌梗死(AMI)早期(入院24h内)β受体阻滞剂的使用情况。方法:采用两阶段随机抽样设计。第一阶段,通过简单随机抽样确定西部农村协作医院;第二阶段,选取2001年、2006年和2011年三个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,进行中心性病历信息提取。比较西部农村AMI患者入院24h内β受体阻滞剂的使用变化趋势,采用多因素模型分析其使用的影响因素。结果:抽取35家医院(其中32家最终参加),从抽样获取的AMI病历中排除不适宜评价β受体阻滞剂使用的人群,最终获得无β受体阻滞剂禁忌证的AMI病历486例,其中247例适宜早期使用β受体阻滞剂,239例存在高休克风险。入院24h内β受体阻滞剂使用率于2001年、2006年和2011年在适宜人群中分别为19.06%、54.30%和56.20%(趋势P=0.0020),在休克高风险人群中分别为31.53%、59.49%和69.62%(趋势P=0.0001)。适宜人群中,高血压病史[比值比(OR)=1.87,95%可信区间(CI):1.06~3.29],吸烟(OR=1.97,95%CI:1.11~3.48),或在2006年(OR=2.93,95%CI:1.22~7.03)、2011年(OR=4.67,95%CI:2.06~10.59)入院与入院24h内β受体阻滞剂使用率高相关。结论:我国西部农村地区AMI患者中,入院24h内β受体阻滞剂的使用自2001年至2011年呈上升趋势,但仍与指南推荐存在较大差异,提高其使用规范性有助于改善AMI诊疗质量及患者预后。Objective： To assess the trend of early beta receptor blocker （β-blocker） application （with 24h of admission） for acute myocardial infarction （AMI） patients in western rural China from 2001 to 2011. Methods： A 2-stage random sampling design was performed. The 1st stage： a simple random sampling was used to identify participating hospitals and the 2nd stage： a systematic random sampling approach was conducted in 3 specific years of 2001, 2006 and 2011 to take case study for central medical information abstraction. The changing trends and impact factors of early β-blocker application for AMI patients in western rural area were assessed by multivariate model analysis. Results： 35 hospitals were sampled and 33 of them were finally participated. With necessary exclusion, a total of 486 AMI patients without β-blocker contraindication were enrolled for 2 groups： Suitable group, the patients were suitable for early β-blocker application, n=247 and High risk group, the patients with the high risk for shock occurrence, n=239. The application rates for β-blocker within 24h of admission at 2001, 2006 and 2011 in Suitable group were 19.06%, 54.30% and 56.20%, Ptrend=0.0020; in High risk group were 31.53%, 59.49% and 69.62%, Ptrend=0.0001. In Suitable group, the patients with history of hypertension （OR=1.87, 95% CI 1.06-3.29）, smoking （OR=1.97, 95% CI 1.11-3.48） or admitted in 2006 （OR=2.93, 95% CI 1.22-7.03） and 2011（OR=4.67, 95% CI 2.06-10.59） had the higher chance to use β-blocker within 24h of admission. Conclusion： Application of β-blocker within 24h of admission in AMI patients presented the increasing trend in western rural China from 2001 to 2011, while there was still difference from the guideline recommendation. Improved normative application of β-blocker is helpful to enhance the quality of care and prognosis in AMI patients.

关 键 词：心肌梗死 Β受体阻滞剂 西部农村 

分 类 号：R54[医药卫生—心血管疾病]