本文選題：心肌梗死 + 心肌再灌注��； 參考：《中國循環(huán)雜志》2017年01期

【摘要】：目的:比較我國省級、市級及縣級三個級別醫(yī)院針對ST段抬高型急性心肌梗死(STEMI)患者進行再灌注治療和住院期間二級預防藥物的使用情況。方法:中國急性心肌梗死注冊(CAMI)研究在2013-01-01至2014-09-30期間共登記覆蓋全國31個省市、自治區(qū)和直轄市107家醫(yī)院收治的18967例在發(fā)病7天內(nèi)的STEMI患者,其中223例患者因住院結局等關鍵數(shù)據(jù)缺失而被排除,分析省、市和縣級三個級別醫(yī)院收治患者的人口統(tǒng)計學信息、再灌注治療[包括急診冠狀動脈介入治療(PCI)和溶栓治療]和二級預防用藥[包括阿司匹林、P2Y12抑制劑、他汀類藥物、β受體阻滯劑、血管緊張素轉(zhuǎn)化酶抑制劑(ACEI)/血管緊張素Ⅱ受體拮抗劑(ARB)]的使用情況。結果:在分析的18744例STEMI患者中,9885例(52.7%)接受了再灌注治療,其中8038例(42.9%)接受了急診PCI,1847例(9.9%)接受了溶栓治療。省級醫(yī)院再灌注治療率明顯高于地市級醫(yī)院和縣級醫(yī)院,分別為4041例(61.8%)、4728例(49.1%)和1116例(43.2%),差異有統(tǒng)計學意義(P0.001);三個級別醫(yī)院的再灌注治療方式也存在明顯差別,省級醫(yī)院:急診PCI 3840例(58.7%),溶栓201例(3.1%);市級醫(yī)院:急診PCI 3753例(39.0%),溶栓975例(10.1%);縣級醫(yī)院:急診PCI 445例(17.2%),溶栓671例(26.0%)。發(fā)病12小時內(nèi)到達醫(yī)院的12502例患者中有8856例(70.8%)接受再灌注治療,其中急診PCI 7089例(56.7%),溶栓1746例(14.1%),省級醫(yī)院3537例(80.0%),市級醫(yī)院4274例(67.5%),縣級醫(yī)院1045例(59.8%),三個級別的醫(yī)院依然差別明顯(P0.001)。在住院期間有16575例(90.9%)使用他汀、17963例(96.8%)使用阿司匹林,17922例(96.5%)例應用P2Y12抑制劑,12657例(68.2%)使用β受體阻滯劑,10541例(56.8%)使用ACEI/ARB。三個級別醫(yī)院在應用上述幾種二級預防用藥比例相似。結論:CAMI研究中,在發(fā)病12小時內(nèi)到達醫(yī)院的患者中,有70.8%接受再灌注治療�？h級醫(yī)院的再灌注治療率明顯較低。三個級別醫(yī)院的二級預防用藥情況相似,但β受體阻滯劑和ACEI/ARB使用比例偏低。
[Abstract]:Objective: to compare the use of secondary prophylaxis in patients with ST-segment elevation acute myocardial infarction (STEMI) in provincial, municipal and county hospitals. Methods: a total of 18967 patients with STEMI were enrolled in 107 hospitals in 31 provinces, autonomous regions and municipalities in China from January, 2013 to September 30, 2013-01-01 to 2014-09-30. Among them, 223 patients were excluded because of lack of key data such as hospitalization outcome. The demographic information of the patients admitted to three level hospitals at the provincial, municipal and county levels was analyzed. Reperfusion [including emergency coronary intervention (PCI) and thrombolytic therapy] and secondary prophylaxis [including aspirin P2Y12 inhibitors, statins, beta blockers, Angiotensin converting enzyme inhibitor (ACEI) / angiotensin 鈪，

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