二级医院急性冠状动脉综合征治疗现状与指南的差距

Disparity between the present management of acute coronary syndrome in the basic secondary hospital and the guidelines

目的:了解二级医院急性冠状动脉综合征(ACS)治疗现状与指南的差距。方法:对119例ACS患者的治疗情况进行回顾性分析,其中64例为ST段抬高型心肌梗死(STEMI组),55例为非ST段抬高型心肌梗死或不稳定型心绞痛(NSTEMI/UAP组)。结果:STEMI组中,18例行尿激酶静脉溶栓治疗,NSTEMI/UAP组住院期间未进行任何再灌注治疗;23例住院稳定后转院择期经皮冠状动脉介入治疗,其中STEMI组与NSTEMI/UAP组分别为29.7%和7.3%。在STEMI组与NSTEMI/UAP组中使用阿司匹林分别为98.4%和98.2%,氯吡格雷92.2%和67.3%,血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂73.4%和83.6%,他汀类调脂药98.4%和92.7%,β受体阻滞剂60.9%和78.2%,低分子量肝素(LMWH)93.8%和72.7%,硝酸酯类药82.8%和94.5%,钙离子拮抗剂0.3%和12.7%,中成药82.8%和90.9%;2组比较,STEMI组中氯吡格雷和LMWH及再灌注治疗高于NSTEMI/UAP组(P<0.01),而β受体阻滞剂少于NSTEMI/UAP组(P<0.05)。结论:在基层二级医院治疗ACS中,治疗STEMI执行指南比NSTEMI/UAP要好,二者仍有一定的提升空间。

Objective：To explore the disparity between the treatment of different types of acute coronary syndrome（ACS） in the basic secondary hospital and the guidelines.Methods：A retrospective analysis was performed on 119 ACS patients.Among them,64 suffered from ST-segment elevation myocardial infarction（STEMI） and 55 non-ST elevation myocardial infarction（NSTEMI） or unstable angina pectoris（UAP）.Results：Among the 64 cases of STEMI,18 received urokinase thrombolytic therapy;23 patients in the STEMI group（29.7%） and NSTEMI/UAP group（7.3%） were transferred to other hospitals to receive percutaneous coronary intervention（PCI） treatment（35.9%） when in stable condition.The difference was significant.Among the patients in STEMI group and NSTEMI/UAP group 98.4% and 98.2% were respectively administered Aspirin,92.2% and 67.3% clopidogrel,73.4% and 83.6% angiotensin converting enzyme inhibitors or angiotensinⅡreceptor antagonist,98.4% and 92.7% statins,60.9% and 78.2% β receptor blockers,93.8% and 72.7% low molecular weight heparin（LMWH）,82.8% and 94.5% nitrate drug,0.3% and 12.7% calcium channel blockers（CCB）,and 82.8% and 90.9% Chinese medicine.The clopidogrel,LMWH and reperfusion therapy were more often used in the STEMI group than in the NSTEMI/UAP group（P〈0.01）,while β-blocker and nitrate drugs were less used（P〈0.05）.Conclusions：The guidelines are better implemented in management of STEMI than that of NSTEMI/UAP in basic secondary hospitals.There are still chances to improve.