中国急性ST段抬高型心肌梗死患者院前应用硝酸甘油或中成药对症状改善及梗死相关动脉血流影响的比较研究  

Comparison of Prehospital Nitroglycerin or Traditional Chinese Medicine Use on Symptom Improvement and TIMI Flow in Infarction-related Artery Among Patients With ST-segment Elevation Myocardial Infarction

作　　者：赵广玉 王朵儿 杨进刚[1] 鲁晔 陶水英 程晓曙[3] 叶君明[4] 贺春晖 吴超[1] 许海燕[1] 乔树宾[1] 赵延延 王杨[2] 李卫[2] 高晓津[1] 杨跃进[1] 中国急性心肌梗死注册研究组 ZHAO Guangyu;WANG Duoer;YANG Jingang;LU Ye;TAO Shuiying;CHENG Xiaoshu;YE Junming;HE Chunhui;WU Chao;XU Haiyan;QIAO Shubin;ZHAO Yanyan;WANG Yang;LI Wei;GAO Xiaojin;YANG Yuejin;Chinese Acute Myocardial Infarction Registry Group(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Medical Research&Biometrics Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 102308,China;Department of Cardiology,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Cardiology,Pingxiang People's Hospital,Pingxiang 337055,China;不详)

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,阜外医院冠心病中心,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院医学统计部,北京102308 [3]南昌大学第二附属医院心血管内科,南昌330006 [4]萍乡市人民医院心血管内科,萍乡337055 [5]不详

出　　处：《中国循环杂志》2024年第1期41-47,共7页Chinese Circulation Journal

基　　金：国家“十二·五”科技支撑计划课题(2011BAI11B02);中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-050)。

摘　　要：目的:比较中国急性ST段抬高型心肌梗死(STEMI)患者院前应用硝酸甘油或中成药对症状改善及对梗死相关动脉(IRA)血流的影响。方法:依托中国急性心肌梗死注册研究于2013年1月1日至2014年3月31日期间,纳入全国108家医院7 d内发病且明确报告院前使用或不使用硝酸甘油或中成药的13064例STEMI患者(已排除共用两类药物患者),其中5280例患者接受了急诊冠状动脉造影。对比使用两类药物对患者症状缓解及IRA的TIMI血流分级水平的影响,其中症状缓解包括完全缓解(症状消失)和部分缓解(不同程度缓解)。结果:13064例患者中,2892例(22.1%)院前应用了硝酸甘油或中成药,其中1149例(8.8%)使用了硝酸甘油,1743例(13.3%)使用了中成药,10172例院前未用药。应用硝酸甘油或中成药的患者,6 h内到达医院的比例(57.4%vs.60.8%vs.50.3%,P<0.0010),与使用院前急救系统的比例(11.8%vs.12.2%vs.9.5%,P=0.0004)均高于未用药的患者。使用硝酸甘油的患者部分缓解比例高于使用中成药的患者(33.8%vs.25.1%,P<0.0010)。多因素Logistic分析显示,使用硝酸甘油较使用中成药完全和部分缓解的可能性较高(OR=1.331,95%CI:1.129~1.569,P=0.0007)。使用硝酸甘油或中成药的患者与未用药患者的院内死亡率相似。在接受急诊冠状动脉造影的患者中,使用中成药或硝酸甘油及未用药患者IRA的TIMI血流达到2~3级的比例分别为21.6%、15.8%和19.3%(P=0.0405)。多因素Logistic回归分析显示,与未用药患者相比,使用中成药患者的TIMI血流达到2~3级水平无明显优势(OR=0.856,95%CI:0.705~1.040,P=0.1171),使用硝酸甘油的患者TIMI血流达到2~3级水平可能性降低(OR=0.666,95%CI:0.495~0.895,P=0.0071)。结论:中国约有22.1%的STEMI患者院前单用硝酸甘油或中成药,含服硝酸甘油对症状改善作用优于中成药,与未用药患者相比,应用这两类药物的患者的TIMI血流未见明显改善。Objectives:To compare the impact of prehospital utilization of nitroglycerin or Chinese traditional medicine(TCM)on symptom improvement and TIMI blood flow in infarct-related arteries(IRA)among patients with ST-segment elevation myocardial infarction(STEMI)in China.Methods:Data from Chinese Acute Myocardial Infarction Registration Study were screened.From January 1,2013 to March 31,2014,13064 STEMI patients who developed symptoms within 7 days in 108 hospitals across the country and explicitly reported using or not using nitroglycerin or TCM before hospital(excluding those sharing two types of drugs)were included in this study.The effects of the two classes of drugs on symptom remission(symptoms disappeared)and partial remission(symptoms alleviated to varying degrees)were compared with the TIMI blood grading level of the IRA.Results:Among the 13064 patients,a total of 2892 patients(22.1%)used prehospital nitroglycerin or TCM,among which 1149 patients(8.8%)used nitroglycerin,1743 patients(13.3%)used TCM,10172 cases did not take medication before hospital.Patients who received nitroglycerin and TCM had a higher proportion of hospital arrival within 6 hours and utilization of emergency medical systems(57.4%vs.60.8%vs.50.3%,P<0.0010).The proportion of patients with prehospital emergency care system(11.8%vs.12.2%vs.9.5%,P=0.0004)was higher than that of patients without medication.The proportion of partial symptom relief in patients with nitroglycerin was significantly higher than in the TCM group(33.8%vs.25.1%,P<0.0010).Multivariate logistic analysis showed that compared to patients treated with TCM,patients treated with nitroglycerin had a higher odds of complete and partial symptom relief(OR=1.331,95%CI:1.129-1.569,P=0.0007).Rates of in-hospital mortality and other adverse events were similar among patients who used prehospital nitroglycerin,TCM,and those who did not use any medication.Among patients who underwent emergency coronary angiography(CAG),the proportion of IRA TIMI blood flow reaching grade 2-3 were 21.6%

关 键 词：急性ST段抬高型心肌梗死 硝酸甘油 中成药 症状改善 TIMI血流 

分 类 号：R54[医药卫生—心血管疾病]