中国中西部城市医院急性心肌梗死住院患者2001、2006、2011年β受体阻滞剂早期使用变化趋势

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摘要目的评价2001~2011年中国中西部城市医院急性心肌梗死（AMI）早期（入院24 h内）适宜服用β受体阻滞剂的住院患者中β受体阻滞剂的应用趋势并探讨其使用影响因素。方法本研究利用两阶段抽样方法，首先采用简单随机抽样方法确定中西部城市地区协作医院，然后根据研究要求，选取2001、2006、2011年住院病历，利用系统随机抽样方法，确定研究病历，进行中心性数据提取。利用加权计算方法评估中西部城市医院总体情况。采用Logistic回归模型分析影响β受体阻滞剂使用的因素。结果 705例β受体阻滞剂早期使用绝对适宜人群纳入研究。2001、2006、2011年，β受体阻滞剂在入院24 h内的使用率分别为55.5%、74.6%和62.6%（趋势P值=0.5927）。入院时有胸部不适症状（OR值为2.22，95% CI：1.21~4.08）的患者更倾向于早期服用β受体阻滞剂。结论我国中西部城市地区医院，入院后24 h内适宜使用β受体阻滞剂的AMI患者中，2001~2011年整体使用显著不足，且无改善趋势，亟需采取措施，加强医生对指南的理解及依从性，改善患者预后。

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	张丽华张海波白雪珂霍西茜刘佳敏蒋立新

关键词 ： &beta, 受体阻滞剂, 急性心肌梗死, 趋势

Abstract：Objective To assess trends of early beta-blocker use during hospitalization for ideal patients with acute myocardial infarction (AMI) and to analyze factors associated with not being treated in Central-Western Urban China from 2001 to 2011. Methods Two-stage random sampling design was used to create a representative sample of patients in Central-Western Urban China admitted to hospital for AMI. In the first phase, a simple random-sampling procedure was used to identify participating hospitals. In the second stage, a systematic sampling approach was applied for selecting patients admitted to each participating hospitals for AMI in 3 years (2001, 2006 and 2011). Then clinical information was obtained via central medical record abstraction for each patients. Weight calculation was used for each year to represent the overall situation. Logistic regression model was used to identify factors associated with early beta-blocker use. Results Finally 705 ideal candidates were included in study. Beta-blocker was used 55.5% in 2001, 74.6% in 2006, and 62.6% in 2011 (P=0.5927 for trend). Chest discomfort (OR=2.22，95% CI: 1.21-4.08) was found as the predictor of non-treatment. Conclusion The use of early beta-blocker therapy in Central-Western Urban China is suboptimal for ideal AMI patients who could definitely benefit from it. Patterns of use have not changed over time. It is urgent to implement strategy to improve clinician guidance adherence and quality of care for AMI.

Key words： Beta-blocker therapy Acute myocardial infarction Trends

基金资助:国家科技支撑计划项目（2013BAI09B01）；
卫生部卫生公益性行业科研专项（201202025）。

通讯作者: 蒋立新（1966.7-），女，博士，主任医师，博士生导师，中国医学科学院阜外医院副院长，国家心血管病中心主任助理，国家卫生计生委心血管药物临床研究重点实验室主任，国家临床医学研究中心常务副主任，中国牛津国际医学研究中心联合主任，心血管生物样本资源中心主任；主要研究方向为卫生经济学与卫生政策、全球健康、大规模人群流行病学、医疗质量评价及结果评价。

引用本文:

张丽华张海波白雪珂霍西茜刘佳敏蒋立新. 中国中西部城市医院急性心肌梗死住院患者2001、2006、2011年β受体阻滞剂早期使用变化趋势[J]. 中国医药导报, 2017, 14(33): 69-73.
ZHANG Lihua ZHANG Haibo BAI Xueke HUO Xiqian LIU Jiamin JIANG Lixin . Early beta-blocker use in acute myocardial infarction in Central-Western Urban China in 2001, 2006, 2011. 中国医药导报, 2017, 14(33): 69-73.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I33/69

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