急性心肌梗死诊断和治疗指南对基层医院开展二级预防的影响

THE EFFECT OF GUIDELINES FOR DIAGNOSIS AND TREATMENT OF ACUTE MYOCARDIAL INFARCTION ON SECOND-LEVEL PREVENTION AT BASIC-LEVEL HOSPITALS

目的探讨急性心肌梗死诊断和治疗指南（简称为指南）对我院心肌梗死后病人二级预防的影响.方法回顾分析2000年1月～2004年12月间我院确诊的急性心肌梗死病例,并进行长期随访.对比2001年指南发布前后心肌梗死后病人二级预防状况的差异.结果共有375例病人入选,指南发布前（2000年1月～2001年12月）165例,发布后（2003年1月～2004年12月）210例.指南发布后,β-受体阻滞剂和他汀类降脂药的使用率均较指南发布前显著提高（χ^2=3.87、64.40,P〈0.01、0.05）;低密度脂蛋白胆固醇水平较前显著降低（t=2.59,P〈0.05）;梗死后心绞痛和脑卒中发生率较前显著降低（χ^2=6.60、4.10,P〈0.05）.结论 2001年指南发布后我院心肌梗死后二级预防水平逐步提高,病人预后显著改善.

Objective To evaluate the influence of the Guidelines for Diagnosis and Treatment of Acute Myocardial Infarction on second-level prevention of post-myocardlal-infarction patients in our hospital. Methods A retrospective study was carried out among the patients with acute myocardial infarction in our hospital from January 2000 to December 2004. Of whom, 375 patients were enrolled in the study. Results It was 165 patients between 2000 and 2001, and 210 between 2002 and 2004. After the guidelines issued, Beta-blockers, statins were used more extensively （X^2= 3. 87, 64. 40; P〈 0. 05 , 0. 01 ）, the level of LDL-C decreased more obviously （t=2.59, P〈S0.05）, the incidence of angina after myocardial and cerebral stroke were lower than before X^2= 6.60,4.10, P〈S0.05）. Conclusion After the Guidelines issued in 2001, great improvement in the secondary prevention and better prognosis of myocardial infarction have been made.