中国中西部城市医院急性心肌梗死住院患者2001、2006、2011年β受体阻滞剂早期使用变化趋势  

Early beta-blocker use in acute myocardial infarction in Central-Western Urban China in 2001, 2006, 2011

作　　者：张丽华 张海波 白雪珂 霍西茜 刘佳敏 蒋立新 

机构地区：[1]中国医学科学院阜外医院国家心血管病中心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,北京100037

出　　处：《中国医药导报》2017年第33期69-73,共5页China Medical Herald

基　　金：国家科技支撑计划项目(2013BAI09B01);卫生部卫生公益性行业科研专项(201202025)

摘　　要：目的评价2001~2011年中国中西部城市医院急性心肌梗死(AMI)早期(入院24 h内)适宜服用β受体阻滞剂的住院患者中β受体阻滞剂的应用趋势并探讨其使用影响因素。方法本研究利用两阶段抽样方法,首先采用简单随机抽样方法确定中西部城市地区协作医院,然后根据研究要求,选取2001、2006、2011年住院病历,利用系统随机抽样方法,确定研究病历,进行中心性数据提取。利用加权计算方法评估中西部城市医院总体情况。采用Logistic回归模型分析影响β受体阻滞剂使用的因素。结果 705例β受体阻滞剂早期使用绝对适宜人群纳入研究。2001、2006、2011年,β受体阻滞剂在入院24 h内的使用率分别为55.5%、74.6%和62.6%(趋势P值=0.5927)。入院时有胸部不适症状(OR值为2.22,95%CI:1.21~4.08)的患者更倾向于早期服用β受体阻滞剂。结论我国中西部城市地区医院,入院后24 h内适宜使用β受体阻滞剂的AMI患者中,2001~2011年整体使用显著不足,且无改善趋势,亟需采取措施,加强医生对指南的理解及依从性,改善患者预后。Objective To assess trends of early beta-blocker use during hospitalization for ideal patients with acute myocardial infarction （AMI） and to analyze factors associated with not being treated in Central-Western Urban China from 2001 to 2011. Methods Two-stage random sampling design was used to create a representative sample of patients in Central-Western Urban China admitted to hospital for AMI. In the first phase, a simple random-sampling procedure was used to identify participating hospitals. In the second stage, a systematic sampling approach was applied for selecting patients admitted to each participating hospitals for AMI in 3 years （2001, 2006 and 2011）. Then clinical information was obtained via central medical record abstraction for each patients. Weight calculation was used for each year to represent the overall situation. Logistic regression model was used to identify factors associated with early beta-blocker use. Results Finally 705 ideal candidates were included in study. Beta-blocker was used 55.5% in 2001, 74.6% in 2006, and 62.6% in 2011 （P=0.5927 for trend）. Chest discomfort （OR=2.22,95% CI： 1.21-4.08） was found as the predictor of non-treatment. Conclusion The use of early beta-blocker therapy in Central-Western Urban China is suboptimal for ideal AMI patients who could definitely benefit from it. Patterns of use have not changed over time. It is urgent to implement strategy to improve clinician guidance adherence and quality of care for AMI.

关 键 词：Β受体阻滞剂 急性心肌梗死 趋势 

分 类 号：R542.22[医药卫生—心血管疾病]