本文選題：冠心病 + 二級預防�。� 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：背景:冠心病是發(fā)達國家的主要死亡原因,隨著我國人民飲食習慣改變和生活水平提高,心血管疾病發(fā)病率和死亡率急劇升高,已成為危害人群健康的主要殺手,罹患冠心病的人群數量龐大,急性心肌梗死幸存者后續(xù)發(fā)病風險和死亡率是普通人群的1.5-15倍[1]。近幾十年來國內外心血管領域一直致力于冠心病的救治與預防,如何提高心血管病的防治水平,以改善心血管病患者的長期預后是目前亟待解決的重要問題。大規(guī)模臨床隨機試驗不斷的實施與更新,提供了有力的循證醫(yī)學證據。國際上各國指南一致推薦,除了持續(xù)改變生活方式外,應用抗血小板、β受體阻滯劑(BBs),他汀類調脂藥物、血管緊張素轉換酶抑制劑/血管緊張素受體拮抗劑(ACEI/ARB)四種藥物組合作為冠心病二級預防治療的基石,可以顯著減少心力衰竭、腦卒中、猝死或再梗死等一系列心血管事件的發(fā)生,提高CHD患者的生存率。目的:調查冠心病二級預防用藥現(xiàn)狀以及與用藥相關的影響因素,了解臨床實際與指南之間存在的差異,為臨床醫(yī)生治療冠心病提供資料參考,促進其規(guī)范化用藥。方法:收集2011年1月到2015年12月從我院心內科出院的明確診斷為冠心病的患者的臨床資料,采用回顧性研究的方法,對所納入人群的一般特點,有循證依據的冠心病二級預防藥物,包括抗血小板、他汀類藥物、β受體阻滯劑和ACEI/ARB,其出院帶藥情況以及用藥影響因素進行統(tǒng)計和分析,P0.05有統(tǒng)計學意義。結果:⑴符合條件的冠心病患者共1150例,男性806例(70.1%),女性344例(29.9%),平均年齡63.1±6.4歲,其中約1/3患者有心肌梗死病史,超過2/3的患者接受過血運重建,合并癥比例從高到低依次為高脂血癥736例(64.0%),高血壓702例(61.0%),糖尿病414例(36.0%),心力衰竭172例(15.0%),缺血性腦卒中62例(5.4%),慢性腎病39例(3.4%);⑵指南推薦藥物服用情況:抗血小板藥物服用率最高為98.5%,他汀類97.8%,β受體阻滯劑55.7%,ACEI/ARB服用率最低為38.3%;⑶多因素回歸分析顯示:抗血小板和他汀類藥物在接受血運重建、高脂血癥、無心力衰竭組使用率高,β受體阻滯劑在心肌梗死、高血壓、高脂血癥、心力衰竭組使用率高,ACEI/ARB類在高血壓、心力衰竭組使用率高,差異均有統(tǒng)計學意義(P0.05)。結論:從冠心病二級預防出院帶藥情況來看,抗血小板、他汀類藥物的使用率高,基本能夠遵循指南的建議,而β受體阻滯劑、ACEI/ARB藥物使用情況不甚理想,與指南要求差距大,需引起重視,故而臨床上仍需堅持對醫(yī)生的繼續(xù)教育,同時加強患者慢性疾病的管理,提高患者對疾病的認知度,使用藥更加個體化合理化,增加用藥依從性,盡可能降低死亡風險,改善患者生存質量。
[Abstract]:Background: coronary heart disease (CHD) is the main cause of death in developed countries. With the change of dietary habits and the improvement of living standards, the morbidity and mortality of cardiovascular diseases have increased sharply, and have become the main killers of the health of the population. The number of people suffering from coronary heart disease (CHD) is large, and the risk of subsequent morbidity and mortality of survivors of acute myocardial infarction is 1.5-15 times higher than that of the general population. In recent decades, the field of cardiovascular disease at home and abroad has been committed to the treatment and prevention of coronary heart disease, how to improve the level of prevention and treatment of cardiovascular disease in order to improve the long-term prognosis of cardiovascular disease patients is an important issue to be solved. Large-scale randomized trials continue to be implemented and updated to provide strong evidence-based medical evidence. In addition to continuing lifestyle changes, international guidelines have consistently recommended the use of antiplatelet, beta-receptor blockers, and statin lipids. The combination of angiotensin converting enzyme inhibitor / angiotensin receptor antagonist ACEI / ARB as the cornerstone of secondary preventive therapy for coronary heart disease can significantly reduce heart failure and stroke. A series of cardiovascular events, such as sudden death or re-infarction, increase the survival rate of CHD patients. Objective: to investigate the current situation of secondary prophylaxis of coronary heart disease (CHD) and its influencing factors, to understand the differences between clinical practice and guidelines, to provide references for clinicians in the treatment of coronary heart disease and to promote their standardized drug use. Methods: from January 2011 to December 2015, the clinical data of patients with coronary heart disease (CHD) who were discharged from our hospital from cardiology department were collected, and the general characteristics of the people involved were analyzed by retrospective study. Evidence-based coronary heart disease prevention drugs, including anti-platelet, statins, 尾 -receptor blockers and ACEI / ARB, the discharge drug status and drug use factors were statistically significant. Results there were 1150 patients with coronary heart disease who met the criteria of 1: 1, 806 men with 70.1 and 344 women with an average age of 63.1 鹵6.4 years. About one third of the patients had a history of myocardial infarction, and more than two thirds of the patients had undergone revascularization. The incidences of complications from high to low are 736 cases of hyperlipidemia (64.0%), 702 cases of hypertension (61.0%), 414 cases of diabetes (36.0%), 172 cases of heart failure (15.0%), 62 cases of ischemic stroke (62 cases) and 39 cases of chronic nephropathy (39 cases). The highest drug use rate was 98.5%, statin 97.8am, 尾 receptor blocker 55.7% ACEI / ARB lowest 38.3% multivariate regression analysis showed that antiplatelet and statins were undergoing revascularization. The utilization rate of 尾 receptor blockers in myocardial infarction, hypertension, hyperlipidemia, heart failure group was high ACEI / ARB group was high in hypertension and heart failure group, the difference was statistically significant (P 0.05). Conclusion: according to the condition of secondary prevention and discharge from coronary heart disease, the use of antiplatelet and statins is high and can basically follow the recommendations of the guidelines, while the use of 尾 receptor blocker ACEI / ARB is not very good, which is far from the requirements of the guidelines. We should pay attention to it, so we still need to insist on continuing education for doctors, strengthen the management of patients' chronic diseases, improve the patients' awareness of the disease, rationalize the use of drugs more individualized, and increase the compliance of drug use, at the same time, it is necessary to strengthen the management of patients' chronic diseases. Minimize the risk of death and improve the patient's quality of life.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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