本文選題：急性心肌梗死　切入點(diǎn)：血管緊張素轉(zhuǎn)化酶抑制劑　出處：《臨床心血管病雜志》2017年03期 　論文類型：期刊論文

【摘要】：目的:評(píng)價(jià)2001~(-2)011年中國(guó)西部農(nóng)村地區(qū)急性心肌梗死(AMI)患者血管緊張素轉(zhuǎn)化酶抑制劑和血管緊張素受體阻滯劑(ACEI/ARB)的使用情況及影響因素。方法:采用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、2006和2011年有代表性的西部農(nóng)村AMI患者的臨床信息。為估算出3個(gè)研究年份ACEI/ARB的使用率和變化趨勢(shì),對(duì)每年度的數(shù)據(jù)分別進(jìn)行加權(quán)計(jì)算,以代表西部農(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:32家西部農(nóng)村醫(yī)院參加研究,入選999份AMI病例,其中中國(guó)指南Ⅰ類推薦組967例,Ⅱa類推薦組32例。2001、2006和2011年,指南Ⅰ類推薦患者ACEI/ARB加權(quán)使用率分別為56.1%、62.5%和67.6%,有明顯改善(趨勢(shì)P值=0.01);指南Ⅱa類推薦患者為41.1%、28.9%和49.3%,無明顯改善(趨勢(shì)P值=0.59)。在3個(gè)研究年份中,ACEIs使用率均顯著高于ARBs。多因素分析顯示,吸煙(OR:1.43,95%CI:1.09~1.88)、合并高血壓(OR:2.84,95%CI:2.08~3.89)和心力衰竭(OR:1.91,95%CI:1.25~2.94)的患者更傾向于使用ACEI/ARB。相反,非ST段抬高型心肌梗死(OR:0.45,95%CI:0.29~0.70)、估計(jì)腎小球?yàn)V過濾(eGFR)60ml·min~(-1)·1.73m~(-2)(OR:0.52,95%CI:0.29~0.94)和eGFR 60~89ml·min~(-1)·1.73m~(-2)(OR:0.59,95%CI:0.41~0.86)的患者較少使用ACEI/ARB。結(jié)論:2001~(-2)011年,我國(guó)西部農(nóng)村地區(qū)指南Ⅰ類推薦的AMI患者中ACEI/ARB整體使用率呈明顯上升趨勢(shì),但仍有較大的改善空間。亟待采取針對(duì)性的質(zhì)量改善措施將循證醫(yī)學(xué)證據(jù)及時(shí)準(zhǔn)確地應(yīng)用到臨床實(shí)踐中,以改善患者預(yù)后。
[Abstract]:Objective: to evaluate the use of angiotensin converting enzyme inhibitor and angiotensin receptor blocker (ACEI / ARB) and its influencing factors in patients with acute myocardial infarction (AMI) in rural areas of western China in 2001 / 11. Methods: the data of China PEACE retrospective AMI study were used to evaluate the effect of angiotensin converting enzyme inhibitor (ACE) and angiotensin receptor blocker (ACE / ARB) on patients with acute myocardial infarction (AMI). Two stage random sampling was used to obtain the clinical information of the representative AMI patients in western rural areas in 2001and 2011. In order to estimate the utilization rate and change trend of ACEI/ARB in three study years, the data of each year were weighted respectively. In order to represent the overall situation of rural areas in western China, the influencing factors of their use were analyzed by using binary logistic regression method. Results\\ 9999 cases of AMI were enrolled in the study of 32 rural hospitals in western China, including 967 cases in the group I recommended by China guidelines. Class 鈪，

本文編號(hào)：1634595