浙江两家不同等级医院非ST段抬高急性冠脉综合征诊疗策略分析

Comparison of the Diagnosis and Management of Patients with Non-ST Elevation Acute Coronary Syndrome in Two Hospitals of Different Grade in Zhejiang

目的:对比不同等级医院非ST段抬高急性冠脉综合征患者的诊疗策略,分析其与指南的差距。方法:回顾性调查分析2006年1～12月在浙医一院及余一医院心内科住院的484例非ST段抬高急性冠脉综合征患者的诊断治疗策略变化。结果:浙医一院患者检查动态心电图、运动平板心电图、负荷核素心肌显像比例均比余一医院明显高,冠脉造影检查率显著高,而心脏损伤标记物检查比例偏低(P<0.05);两家医院心电图、心超、胸片、CT冠状动脉成像比例无明显差异(P>0.05)。与余一医院相比,浙医一院阿司匹林、应用阿司匹林负荷量、β-受体阻滞剂、硝酸酯类、氯吡格雷使用比例明显高;住院期间行PCI治疗及早期有创干预均多;但低分子肝素使用比例相对低(P<0.05);而吗啡、β-受体阻滞剂加量、ACEI、钙拮抗剂、普通肝素、GPⅡb/Ⅲa受体拮抗剂、他汀类使用率无显著差异(P>0.05)。结论:不同等级医院NSTE-ACS患者内科住院诊疗策略基本遵循指南,尤其是有创检查及治疗部分,浙医一院甚至优于国外报告;但不同等级医院存在不少差距,特别是阿司匹林及其负荷量、β-受体阻滞剂、硝酸酯类、氯吡格雷使用;而且β-受体阻滞剂使用及加量和GPⅡb/Ⅲa抑制剂的临床使用与循证指南仍存在不少差距,提升空间较大,需进一步提高循证指南的宣传教育。

Objective：To compare the diagnosis and management of patients with Non-ST elevation acute coronary syndrome in two hospitals of different grade, and scale the gap between practice and guidelines. Methods：Clinical data of the diagnosis and management of 484 inpatients mith Non-ST elevation acute coronary syndrome from Jan. to Dec.2006 were retrospectively analyzed. Results：Dynamic electrocardiogram, exercise ECG. cardiac stress imaging and coronary angiography were used more extensively in hospital of grade 3 than those in grade 2 ,but the usage of elevated cardiac markers was lower. Significant difference in the use of aspirin.using 300mg first dosage of aspirin.β -blocker .nitrates. clopidogrel and invasive strategies were found in two hospitals of different grade . Conclusions：The diagnosis and management of patients with Non-ST elevation acute coronary syndrome in two hospitals of different grade obey the guidelines. Still, further improvements are needed for optimal implementation of these guidelines such as the use of β -blocker. adding dosage of β -blocker and GP II b/IIIa inhibitor.