急性心肌梗死诊断和治疗指南发布前后基层住院患者治疗和预后对比分析

Comparable Analysis of the Treatment and Prognosis of the Inpatients in a Basic Level Hospital Before and After Publishing the Guide to Diagnosis and Treatment of Acute Mycocardial Infarction in China

目的：评价急性心肌梗死（AMI）诊断和治疗指南对社区住院AMI患者治疗和预后影响。方法：回顾分析1998年1月～2001年12月（A组）及2002年1月～2005年12月（B组）问在我院住院的所有AMI患者，比较指南发布前后治疗方法、30天病死率及并发症的差异。结果：指南发布后253例患者溶栓治疗率、β受体阻断剂、血管转换酶抑制剂（ACEI）或血管紧张素2受体阻断剂（ARB）类药物、调脂药、肝素的使用率、住院期间心绞痛、心房颤动、室性心动过速、心力衰竭和30天病死率与发布前的367例患者比较差异有显著意义（P〈0．01）。结论：指南对临床治疗AMI效果更加显著、规范化，可提高AMI患者生存率，降低住院期间并发症发生率。

OBJECTIVE：To evaluate the effect of the guide to diagnosis and treatment of acute mycoeardial infaction （AMI） in China＇ on the treatment and prognosis of inpatients with AMI in community hospitals. METHODS： Clinical data of 367 inpatients with AMI from Jan. 1998 to Dec. 2001（group A） and 253 inpatients with AMI from Jan. 2002 to Dec. 2005 （group B） were retrospectively analyzed. Treatment methods before and after publishing the guide, mortality within 30 days and the difference of complications were made a comparable analysis. RESULTS： After publishing the gnide, the rate of thrombolytic therapy, the use of β - blocker, ACEI/or ANG Ⅱ receptor blockers, LWMH and cholesterol - lowering agents were higher in group B than those in group A （P 〈 0.01 ）, but the incidence of angina peetoris, atrial fibrillation, ventrieular tachyeardia, heart failure and mortality within 30 days in group B were lower than those in group A （ P 〈 0.01 ） . CONCLUSION ： ‘ The guide to diagnosis and treatment of AMI in China＇ has obvious effect on the treatment and prognosis of inpatients with AMI. It can make treatment more normalized, improve patients＇ survival and reduced the incidence of inhospital complication.