北京地区急性冠心病事件病死率的变化趋势──MONICA方案的研究结果

The trends of case fatality in acute coronary events and the related medical emergency care in Beijing area

本研究采用国际先进的流行病学方法，在北京地区人群中同步监测冠心病急性发作（主要包括急性心肌梗塞和冠心病猝死）的病死率及有关的医疗抢救水平，了解它们的变化趋势及相互关系。主要研究结果显示：（１）１９８４～１９９１年北京地区急性冠心病事件总的病死率处于较高水平，平均为６４．９％，无明显上升或下降趋势；（２）住院及急诊病人的病死率也处于较高水平，平均为４１．６％，但呈下降趋势；（３）院外死亡占总死亡的比例平均为５４．７％；（４）北京地区对冠心病急性发作总的抢救水平较低，尤其是对在院外发生心脏停搏的病人进行心肺复苏的比例及成功率均较低。本研究为今后有效的改善北京地区冠心病急救水平，降低急性冠心病事件的病死率提供了可靠的依据和方向。

Abstract The trends of case fatality of CAD events (mainly included AMI and coronary sudden death), as well as the related medical emergency care have been monitored simultaneously in 700, 000 population of Beijing since 1984, as a part of Sino-Monica-an international cooperative study. Abstract:The results showed that the total case fatality of acute coronary events (28 days after onset) remained no significant change from 1984 to 1991, with an average rate of 64. 9%. While the hospitalized case fatality of acute coronary events decreased from 57. 6% (1984) to 38. 5%(1991), the proportions of out-hospital death increased,with an average rate of 54. 7%. In hospitals, 35. 3% of death occured in emergency rooms, 34. 5% in CCU,28. 6% in general wards and 1. 6% in other places.The emergency care for acute coronary events outside hospital obviously need improving. The time between onset and medical presence was too long for most patients; and only 15. 6% patients who occured cardic arrest outside hospital received cardiopulmonary resuscitation, with a success rate of 0.1% .The medical care for acute coronary events in hospital improved from 1984 to 1991. The items of serum enzyme examination increased; the proportions of patients admitted to CCU increased from 62. 7% to 71. 4%; and the patients received thrombolytic therapy during hospitalization increases from zero to 8%. But,there still was a large gap between us and those advanced cities in different countries.The study results have provided a much more complete picture about acute coronary events than most hospital-based studies. They are very useful for improving the medical emergency care of CAD, reducing its case fatality in Beijing area.