2006-2011年中西部城市急性心肌梗死患者住院早期氯吡格雷的应用及影响因素  

Assessment of early clopidogrel therapy use among acute myocardial infarction patients in central-western urban China from 2006 to 2011

作　　者：冯芳[1] 张丽华[1] 刘佳敏[1] 胡爽[1] 张海波[1] 余苑 张宁[1] 蒋立新[1] 

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院中国牛津国际医学研究中心,国家心血管疾病临床医学研究中心,心血管疾病国家重点实验室,北京100037

出　　处：《临床心血管病杂志》2017年第7期629-633,共5页Journal of Clinical Cardiology

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(No:201502009);国家科技部科技支撑计划(No:2013BAI09B01,2015BAI12B01,2015BAI12B02)

摘　　要：目的:评价2006-2011年中西部城市地区急性心肌梗死(AMI)患者住院早期氯吡格雷的使用率及变化情况,并探讨影响其使用的因素。方法:采用两阶段随机抽样方法抽取2006年和2011年两个年份的AMI患者病历,提取临床信息,评估入院24h内氯吡格雷的应用情况。采用广义估计方程的多水平logistic回归模型分析影响因素。每年度分别进行加权计算,以代表中西部城市地区整体情况。结果:中西部城市共计32家医院的2 723份AMI病历纳入研究。中位年龄为63岁,女性患者占26.3%。2006-2011年,AMI患者住院早期氯吡格雷使用率从54.2%增加到87.7%(P<0.01)。分析早期氯吡格雷使用的影响因素:入院有胸部不适、ST段抬高型心肌梗死、院内接受溶栓以及PCI患者更易接受氯吡格雷治疗,相反,年龄≥65岁、入院时收缩压≥180mmHg(1mmHg=0.133kPa)或舒张压≥110mmHg患者氯吡格雷使用率低于其他患者。结论:过去6年间,我国中西部城市地区AMI患者住院早期氯吡格雷应用得到显著改善,但仍然有改善空间。Objective：To describe the use of early clopidogrel therapy in patients with acute myocardial infarction（AMI）in central-western urban China from 2006 to 2011,and to identify factors associated with the use of early clopidogrel therapy.Method：We used a two-stage random sampling design to create a representative sample of patients in central-western urban China admitted to hospitals for AMI in 2study years（2006and 2011）.Analysis was conducted based on the patients＇ information obtained from medical records via central abstraction.We collected clinical information of a representative sample of hospitalized patients with AMI in 2006 and 2011.Early clopidogrel therapy was defined as initiation within 24 hours after admission.Logistic regression analysis was used to identify factors related to the use of early clopidogrel therapy.Result：We identified 2 723 eligible patients for early clopidogrel therapy from 32 hospitals,of which median age was 63 years old and 26.3% were female.From2006 to 2011,the weighted rate of early clopidogrel use increased from 58.5%to 87.7%.In logistic regression,patients with chest discomfort,STEMI patients,patients receiving primary PCI or thrombolysis were more likely to be treated with clopidogrel.In contrast,patients aged≥65or systolic blood pressure≥180mmHg（1mmHg=0.133kPa）or diastolic blood pressure≥110mmHg were less likely to be treated with early clopidogrel therapy.Conclusion：During the past 6years in eastern urban China,the use of early clopidogrel has improved substantially among patients with AMI.However,gap still persisted between guideline and clinical practice.Quality improvement initiatives are needed for further improvements in early clopidogrel for patients with AMI.

关 键 词：急性心肌梗死 氯吡格雷 医疗质量 中西部城市 

分 类 号：R541.4[医药卫生—心血管疾病]