【摘要】：目的:了解2001年~2011年間中國中部農(nóng)村急性心肌梗死(AMI)患者血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)和血管緊張素受體阻滯劑(ARB)的使用情況,并探討其影響因素。方法:采用"冠心病醫(yī)療結(jié)果評價(jià)和臨床轉(zhuǎn)化研究——回顧性急性心肌梗死研究"(以下簡稱China PEACE回顧性AMI研究)的數(shù)據(jù),通過兩階段隨機(jī)抽樣獲得2001年、2006年和2011年有代表性的中部農(nóng)村AMI患者的臨床信息。為評估ACEI/ARB使用情況,按照中國指南將患者分為指南Ⅰ類推薦組[包括ST段抬高型心肌梗死(STEMI)和合并心力衰竭、左心室射血分?jǐn)?shù)40%、高血壓或糖尿病的非ST段抬高型心肌梗死(NSTEMI)]和指南Ⅱa類推薦組(無Ⅰ類推薦指征的NSTEMI)。為估算出三個(gè)研究年份ACEI/ARB的使用率和變化趨勢,對每年度的數(shù)據(jù)分別進(jìn)行加權(quán)計(jì)算,以代表中部農(nóng)村整體情況。采用二元Logistic回歸方法分析其使用的影響因素。結(jié)果:35家中部農(nóng)村醫(yī)院參加研究,入選1 657份AMI病例,其中中國指南Ⅰ類推薦組1 580例,指南Ⅱa類推薦組77例。2001年、2006年和2011年,指南Ⅰ類推薦組患者ACEI/ARB加權(quán)使用率分別為61.0%、65.5%和66.5%(趨勢P值=0.15);指南Ⅱa類推薦組患者為57.2%、55.6%和58.4%(趨勢P值=0.89)。兩組人群隨時(shí)間變化ACEI/ARB使用率均無明顯改變。在三個(gè)研究年份中,ACEI使用率均顯著高于ARB。多因素分析顯示,合并高血壓[比值比(OR)=1.73,95%可信區(qū)間(CI):1.28~2.35]、心力衰竭(OR=1.92,95%CI:1.40~2.62)的患者更傾向于使用ACEI/ARB;與入院時(shí)收縮壓90~139 mm Hg(1 mm Hg=0.133 k Pa)相比,收縮壓≥140 mm Hg(OR=1.90,95%CI:1.40~2.62)的患者更容易接受ACEI/ARB,相反,收縮壓90 mm Hg(OR=0.42,95%CI:0.22~0.80)的患者較少使用ACEI/ARB。結(jié)論:2001年~2011年間,我國中部農(nóng)村地區(qū)的AMI患者中ACEI/ARB使用存在明顯不足,且隨時(shí)間推進(jìn)無明顯改善。ACEI/ARB在此類患者中的應(yīng)用亟待改善,以縮小臨床實(shí)踐與循證醫(yī)學(xué)證據(jù)和指南推薦之間的差距,提高醫(yī)療服務(wù)質(zhì)量,改善患者預(yù)后。
[Abstract]:Objective: to investigate the use of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with acute myocardial infarction (AMI) in rural areas of central China from 2001 to 2011 and to explore the influencing factors. Methods: the data of China PEACE retrospective AMI study were used to evaluate the medical outcome and clinical transformation of coronary heart disease. The clinical information of representative rural AMI patients in 2001, 2006 and 2011 were obtained by two-stage random sampling. In order to assess the use of ACEI/ARB, patients were classified according to the Chinese guidelines into guidelines I recommendation group [including (STEMI) with ST segment elevation myocardial infarction and with heart failure, Left ventricular ejection fraction (LVEF), non-ST segment elevation myocardial infarction (NSTEMI) in hypertension or diabetes mellitus] and guidance II-a recommendation group (NSTEMI). Without recommendation I) In order to estimate the utilization rate and change trend of ACEI/ARB in three years, the data of each year were weighted to represent the whole situation of rural areas in central China. The factors influencing its use were analyzed by using binary Logistic regression method. Results one hundred and thirty-five central rural hospitals participated in the study, and 1 657 AMI cases were selected. Of them, 1 580 cases were classified as Chinese guidelines I recommendation group, 77 cases as guideline II a recommendation group, 2001, 2006 and 2011, respectively. The weighted utilization rate of ACEI/ARB in group I was 65.5% and 66.5% (trend P = 0.15), and that in group 鈪，

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