本文選題：急性心肌梗死 + 氯吡格雷��； 參考：《中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào)》2017年06期

【摘要】：目的評(píng)估2006、2011年中國(guó)中部農(nóng)村地區(qū)急性心肌梗死(AMI)患者住院早期氯吡格雷的應(yīng)用情況,并探討其應(yīng)用的影響因素。方法采用兩階段隨機(jī)抽樣設(shè)計(jì),抽取中部農(nóng)村AMI患者代表性樣本。第一階段,采用簡(jiǎn)單隨機(jī)抽樣確定協(xié)作醫(yī)院。第二階段,在協(xié)作醫(yī)院中采用系統(tǒng)隨機(jī)抽樣方法,抽取研究病歷,提取臨床信息,評(píng)估住院早期(入院24 h內(nèi))氯吡格雷應(yīng)用率。采用廣義估計(jì)方程的多水平Logistic回歸模型分析影響住院早期氯吡格雷應(yīng)用的因素。結(jié)果共計(jì)35家醫(yī)院的1464份AMI病歷納入研究。中位年齡為65歲,女性患者占30.7%。2006至2011年,AMI患者住院早期氯吡格雷應(yīng)用率從3.98%增加至48.72%(P0.0001)。多因素模型分析中,高血壓患者住院早期氯吡格雷應(yīng)用率高于非高血壓患者(OR=1.65,95%CI=1.21~2.26,P=0.001),吸煙患者更易接受氯吡格雷早期治療(OR=1.87,95%CI=1.19~2.95,P=0.007),入院時(shí)存在胸部不適患者早期氯吡格雷應(yīng)用率高于未合并胸部不適患者(OR=2.17,95%CI=1.35~3.49,P=0.001)。結(jié)論 2006至2011年,我國(guó)中部農(nóng)村AMI患者住院早期氯吡格雷應(yīng)用嚴(yán)重不足的局面開始改善,但其應(yīng)用率與指南推薦之間還存在極大差距。因此,亟待全面提高早期氯吡格雷應(yīng)用,進(jìn)一步改善AMI患者的臨床結(jié)局。
[Abstract]:Objective to evaluate the use of clopidogrel in early hospitalization of patients with acute myocardial infarction (AMI) in rural areas of central China in 2006 and 2011 and to explore the influencing factors. Methods A two-stage random sampling design was used to select representative samples of AMI patients from rural areas in central China. In the first stage, simple random sampling was used to determine the cooperative hospital. In the second stage, a systematic random sampling method was used to extract the medical records and clinical information to assess the clopidogrel application rate in the early stage of hospitalization (within 24 hours of admission). Multilevel Logistic regression model with generalized estimation equation was used to analyze the factors affecting clopidogrel application in early hospitalization. Results 1464 AMI cases from 35 hospitals were included in the study. The median age was 65 years old, female patients accounted for 30.7%. The early clopidogrel application rate of AMI patients increased from 3.98% to 48.72% from 2006 to 2011 (P 0.0001). In multifactor model analysis, The early clopidogrel application rate in hypertension patients was higher than that in non-hypertensive patients (OR 1.6595). Smoking patients were more likely to receive clopidogrel early treatment (OR 1.8795 CI 1.192.95U P 0.007). The early clopidogrel application rate in patients with chest discomfort was higher than that in patients without chest discomfort at the time of admission. Conclusion from 2006 to 2011, the situation of severe shortage of clopidogrel in early hospitalization of AMI patients in rural areas of central China began to improve, but there is still a great gap between the application rate and the recommended guidelines. Therefore, it is urgent to improve the early application of clopidogrel and improve the clinical outcome of AMI patients.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院國(guó)家心血管病中心阜外醫(yī)院中國(guó)牛津國(guó)際醫(yī)學(xué)研究中心國(guó)家心血管疾病臨床醫(yī)學(xué)研究中心心血管疾病國(guó)家重點(diǎn)實(shí)驗(yàn)室;
【基金】：國(guó)家衛(wèi)生和計(jì)劃生育委員會(huì)衛(wèi)生公益性行業(yè)科研專項(xiàng)(201202025、201502009) 國(guó)家科技部科技支撐計(jì)劃(2013BAI09B01、2015BAI12B01、2015BAI12B02) 高等學(xué)校學(xué)科創(chuàng)新引智計(jì)劃(B16005)~~
【分類號(hào)】：R542.22

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