北京地区13家中、西医医院急性心肌梗死患者住院治疗状况调查

Survey on the hospitalization treatment status of acute myocardial infarction patients in 13 hospitals of western medicine and traditional Chinese medicine in Beijing

目的了解北京地区13家中、西医医院2005年急性心肌梗死（AMI）住院患者临床特征及治疗状况。方法采用统一调查表，对北京地区13家中、西医医院2005年1月1日至12月31日住院的AMI患者进行登记，共注册1663例AMI患者，其中，7家西医医院1366例，6家中医医院297例。用Access建立数据库，SPSS15．0统计软件对AMI住院患者临床特征及治疗状况进行描述分析。结果AMI患者平均发病年龄（63．9±12．8）岁，男女比例为2．4：1。西医医院发病年龄为（62．8±12．8）岁，男女比例为2．7：1；中医医院发病年龄为（69．1±11．8）岁，男女比例为1．6：1；两者比较，差异均有统计学意义（P〈0．05）。中医医院AMI患者中位来院时间为14h，晚于西医医院的11h，但差异无统计学意义。中医医院既往有心、脑血管病史、伴随有高血压、糖尿病、高脂血症，以及住院期间有心律失常、心功能不全、心原性休克等并发症患者比例均高于西医医院（P〈0．05或P〈0．01）。AMI患者总的病死率为8．2％（137／1663），中医医院病死率高于西医医院[（15．8％（47／297）比6．6％（90／1366），P〈0．01]。13家医院包括急诊经皮冠状动脉介入治疗（PCI）和溶栓在内的再灌注治疗率为31．3％，西医医院再灌注率为33．3％，高于中医医院的21．9％（P〈0．05）。指南建议使用的药物使用率：阿司匹林为93．6％、血管紧张素转换酶抑制剂与血管紧张素Ⅱ受体拮抗剂合计为85．1％、B受体阻滞剂为78．7％、低分子肝素为85．4％、他汀类降脂药为74．7％。结论再灌注治疗已经成为AMI患者重要的治疗手段，指南推荐的药物得到了广泛应用，但仍有较大的提升空间。中医医院AMI患者具有独立的临床特征。加强高危人群的科普教育、推进指南的实施是AMI救治面临的重要课题。

Objective To survey the treatment status and clinical features of hospitalized patients with acute myocardial infarction （AMI） of 13 hospitals in Beijing in 2005. Methods Uniform questionnaires were used to register AMI patients hospitalized from January I to December 31, 2005 in the 13 hospitals including traditional Chinese medicine （TCM） hospitals （n = 6） and western medicine hospitals （WM, n =7） from Beijing. A total of 1663 AMI patients were registered （1366 cases in WM hospitals and 297 cases in TCM hospitals）. An Access database was established and patient informations were inputed, the clinical features and treatment status of hospitalized AMI patients were analyzed. Results The mean age was （63.9 ± 12. 8 ） years old [ （ 62. 8 ± 12. 8 ） years for WM Hospitals and （ 69. 1 ± 11.8 ） years for TCM hospitals, P 〈 0. 05 ], male to female ratio was 2. 4：1 （2. 7：1 for WM hospitals and 1.6：1 for TCM hospitals, P 〈 0. 05 ）. The median time to hospital was 14 hours in TCM hospitals and 11 hours in WM hospitals （ P 〉 0.05 ） . Incidences of history of cerebrovascular disease, high blood pressure, diabetes, hyperlipidemia and complications such as in-patient arrhythmia, cardiac insufficiency, cardiogenic shock were significantly higher in TCM hospitals than in WM hospitals. The total mortality of 1663 AMI cases was 8.2% （ 15.8% in TCM hospitals vs. 6. 6% in WM hospitals, P 〈 0. 01 ）. The reperfusion rate including emergency PCI and thrombolytic therapy rate was 31.3% in 13 hospitals （33.3% in WM hospitals vs. 21.9% in TCM hospitals, P 〈 0. 05）. Percent of guideline recommend drug use for AMI was as follows ： aspirin 93.6%, ACEI and ARB 85.1%, 13-blocker 78.7% , low molecular weight heparin 85.4%, statins 74. 7%. Conclusions Reperfusion therapy and guildline recommended drugs were widely used although there was a need for further improvement. The hospitalized mortality showesd a downward trend compared with results from five years ago, patients in TCM hospitals had an independent clinical features.