东部农村2001-2011年急性心肌梗死患者早期阿司匹林使用趋势  

Trends in Early Aspirin Use for Acute Myocardial Infarction in Eastern Rural China from 2001 to 2011

作　　者：张海波[1] 孙晓彤[1] 白雪珂 冯芳[1] 高岩[1] 赵灵珊 蒋立新[1] 

机构地区：[1]国家心血管病中心中国医学科学院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,北京市100037

出　　处：《中国分子心脏病学杂志》2017年第3期2082-2085,共4页Molecular Cardiology of China

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(201202025;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：背景急性心肌梗死(AMI)在我国发病率及死亡率居高不下,阿司匹林早期使用可明确降低死亡风险,指南推荐无禁忌症患者尽早服用。评价农村地区AMI患者早期阿司匹林的使用情况及影响因素将有利于改善医疗质量。目的评价2001-2011年东部农村AMI患者入院24小时内阿司匹林使用率及变化趋势,并分析可能影响其早期使用的因素。方法采用两阶段随机抽样设计获取2001、2006和2011三个特定年份的AMI病历,提取病历信息。分析阿司匹林在入院24小时内的三个年度的加权使用率及各医院的变化趋势,并通过logistic回归方法分析其使用的影响因素。结果抽取东部农村32家医院参加研究,随机抽样获得2001、2006和2011年无阿司匹林禁忌症的AMI住院病历共2785份。2001、2006及2011年的加权使用率分别为79.1%,78.3%和86.4%(趋势P<0.001)。医院间使用差异逐渐缩小。住在教学医院,或有高血压病史、有胸部不适症状、接受溶栓治疗的患者阿司匹林服用比例相对高;反之,高龄或合并心源性休克的患者较少接受早期阿司匹林治疗。结论东部农村地区AMI住院患者早期阿司匹林使用率2001-2011年呈上升趋势,医院间差异缩小,改善明显。Objective Acute myocardial infarction （AMI） was a common reason for death in China in recent years. Aspirin has been demonstrated to be a high cost-effective treatment strategy for AMI, and is recommended to be used immediately after presentation by clinical guidelines. As its inexpensive, its value for rural area should be more important. The patterns of aspirin use in rural China are still unknown, Methods We used a two-stage random sampling design to create a representative sample of patients in eastern rural China, we randomly selected AMI sample from 2001, 2006 and 2011. Analysis was conducted based on the patients＇ information obtained from medical records via central abstraction. We examined trends of use rates of aspirin in the first 24 hours after admission for AMI, and identified f：actors associated with aspirin use through a logistic regression naodel. Results A total of 2785 AMI cases from 32 hospitals of eastern rural area were included in the study. Early use of aspirin increased from 79.1% in 2001, 78.3% in 2006 to 86.4% in 2011 （p for trend 〈0.001）. Variation between hospitals became smaller from 2001 to 2011. Aspirin was more likely used in patients who admitted to a teaching hospital, had history of hypertension, had chest uncomfortable on presentation, or received thrombolysis therapy. For patients who were elderly （〉65 years）, had cardiogenic shock or non-ST segment elevation myocardial infarction seemed less likely to use this drug. Conclusion Aspirin early use in AMI increased from 2001 to 2011, the variation between hospitals became smaller, great improvement in aspirin use in eastern rural China.

关 键 词：急性心肌梗死 阿司匹林 东部农村 

分 类 号：R542.22[医药卫生—心血管疾病]