成都地区胸痛中心管理模式下非ST段抬高型急性冠脉综合征治疗的指南-实践差距及其影响因素研究  

Guideline-practice Gap and Influencing Factors in the Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome with the Management Mode of Chengdu Chest Pain Center

作　　者：徐学萍 汪汉 崔彩艳 张玉玫 李思艺 朱峰 叶滔[1] 蔡琳 XU Xueping;WANG Han;CUI Caiyan;ZHANG Yumei;LI Siyi;ZHU Feng;YE Tao;CAI Lin(Cardiovascular Department,the Third People's Hospital of Chengdu/the Affiliated Hospital of Southwest Jiaotong University,Chengdu 610031,China;Southwest Jiaotong University College of Medicine,Chengdu 610036,China)

机构地区：[1]四川省成都市第三人民医院西南交通大学附属医院心血管内科,610031 [2]西南交通大学医学院,四川省成都市610036

出　　处：《中国全科医学》2020年第24期3040-3046,共7页Chinese General Practice

基　　金：四川省科技厅应用基础重点研究项目(2018JY0126)。

摘　　要：背景自2014年以来,成都地区持续推动胸痛中心建设,以提高急性冠脉综合征(ACS)的救治水平。目前已有研究报道了非ST段抬高型急性冠脉综合征(NSTE-ACS)患者的临床诊疗存在指南-实践差距,但是尚无关于成都地区NSTE-ACS患者临床诊疗指南-实践差距及其原因分析的研究。目的本研究为多中心回顾性横断面研究。探讨成都地区胸痛中心管理模式下NSTE-ACS治疗的指南-实践差距并分析其影响因素。方法根据纳入与排除标准,最终选取成都地区正在建设和已经建设胸痛中心的三级医院共11家,纳入2017—2018年在这11家医院住院治疗的NSTE-ACS患者1022例。在胸痛中心数据填报平台和11家医院(其中7家为基层版胸痛中心)的电子病历系统中收集NSTE-ACS患者一般资料、治疗策略、在推荐时间内行经皮冠状动脉介入治疗(PCI)情况及出院带药情况。根据《非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016)》中NSTE-ACS患者有创治疗策略风险标准对患者进行危险分层,分为低危(141例,低危组)、中危(178例,中危组)、高危(668例,高危组)和极高危(35例,极高危组)。结果1022例患者中,629例(61.5%)接受了侵入性诊疗(其中388例行PCI)。低危组、极高危组侵入性诊疗率高于中危组,低于高危组(P<0.05)。二元Logistic回归分析结果显示,NSTE-ACS类型、冠心病病史是患者在推荐时间内行PCI的影响因素(P<0.05)。中危组、极高危组出院带阿司匹林(ASA)、他汀类药物率高于低危组,低于高危组(P<0.05);极高危组出院带P2Y12抑制剂、双联抗血小板治疗(DAPT)率高于低危组、中危组,低于高危组(P<0.05);中危组出院带β-受体阻滞剂(BB)率高于低危组、极高危组,低于高危组(P<0.05);高危组出院带血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)、最佳药物治疗(OMT)率低于低危组,高于中危组、极高危组(P<0.05)。二元Logistic�Background Since 2014,Chengdu has continued to promote the construction of Chest Pain Center to improve the treatment of acute coronary syndrome(ACS).At present,studies have reported a guideline-practice gap in the clinical diagnosis and treatment of patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).However,there is no research about the guideline-practice gap in the clinical diagnosis and treatment and its influencing factors in Chengdu.Objective To explore the guideline-practice gap of NSTE-ACS treatment with the management of Chest Pain Center in Chengdu and analyze its influencing factors.Methods A multicenter retrospective cross-sectional study was conducted among 1022 cases of NSTE-ACS receiving inpatient treatment in 11 hospitals with a well-constructed or under construction Chest Pain Center(7 with a primary level center)in Chengdu during 2017 to 2018.General information,treatment strategies,status of percutaneous coronary intervention(PCI)within the recommended time,and discharged medication of these patients were collected from the Chest Pain Center Data Reporting Platform and the electronic medical record system of these 11 hospitals.According to the risk criteria for invasive treatment strategies in the 2016 Chinese Guidelines for the Management of Non-ST-segment Elevation Acute Coronary Syndrome,the patients were divided into low-risk(141 cases),medium-risk(178 cases),high-risk(668 cases),and extremely high-risk(35 cases)groups.Results A total of 629(61.5%)cases underwent invasive diagnosis and treatment(388 underwent PCI).The rate of receiving invasive diagnosis and treatment in low-risk group was higher than that in medium-risk group but was lower than that in high-risk group(P<0.05),and so was that in extremely high-risk group(P<0.05).Binary Logistic regression analysis showed that NSTE-ACS type and history of coronary heart disease were influencing factors for undergoing PCI within the recommended time(P<0.05).Compared with medium-risk group or extremely high-risk group,the

关 键 词：急性冠状动脉综合征 胸痛中心 指南 实践 影响因素分析 成都 

分 类 号：R542.2[医药卫生—心血管疾病]