2001至2011年中国西部农村地区医院急性心肌梗死患者早期阿司匹林使用趋势

Trend of aspirin use in patients with acute myocardial infarction in rural hospitals of Western China from 2001 to 2011

目的 评价2001至2011年中国西部农村地区医院急性心肌梗死（AMI）患者住院早期阿司匹林的使用率、变化趋势及影响因素。 方法 采用两阶段随机抽样设计获取2001、2006、2011年西部农村地区医院AMI患者具有代表性的样本。分析3个研究年份患者水平住院早期阿司匹林加权使用率及变化趋势,以代表西部农村地区医院AMI住院患者的整体情况。分析医院水平阿司匹林使用率时排除入选人数＜5的医院,以期反应医院的整体水平。采用Logistic回归方法分析影响阿司匹林使用的相关因素。 结果 共32家西部农村地区医院的1006例AMI患者纳入研究,患者中位年龄为66岁,女性占26.9%。2001至2011年,阿司匹林早期加权使用率有明显改善（2001年69.9%、2006年84.9%和2011年88.8%,趋势P值＜0.0001）,而且从医院水平看,早期阿司匹林服药率亦呈逐年上升趋势。然而,即使在2011年,仍有2家医院（约占10%）早期阿司匹林使用率低于80%（分别为55.6%和69.2%）。多因素Logistic分析显示,入院时合并胸部不适（OR 4.6,95%CI 2.7～7.8）和有PCI能力医院（OR 3.2,95%CI 1.5～6.7）的患者更倾向于使用阿司匹林,而非ST段抬高型心肌梗死的患者较少使用阿司匹林（OR 0.5,95%CI 0.3～0.8）。 结论 从2001年至2011年,我国西部农村地区医院AMI住院患者中早期阿司匹林使用率呈明显上升趋势,但一些医院和某些特征人群仍有较大的改善空间。

Aim To evaluate trend of early aspirin therapy in patients with acute myocardial infarction （AMI） in western rural hospitals in China from 2001 to 2011, and to identify independent factors associated with the use of early aspirin. Methods Two stage random sampling design was used to obtain representative samples of AMI patients in western rural hospitals from 1,6 and 2011. The weighted use rate and trend of aspirin in patient-level at the early stage of hospitalization in 3 years were analyzed to represent the overall situation of AMI inpatients in western rural areas. When the use rate of aspirin in hospital-level was analyzed, the hospitals with less than 5 enrolled cases were excluded, so as to reflect the overall level of western rural hospital. Logistic regression analysis was used to analyze the related factors affecting aspirin use. Results A total of 1006 AMI patients from 32 western rural hospitals were enrolled in this study. The median age of the patients was 66 years old, and the proportion of women was 26.9%. From 2001 to 2011, early weighted use rate of aspirin was significantly improved （69.9% in 1,4.9% in 2006 and 88.8% in 2011, and trend P value〈0.0001）. From the hospital-level, the rate of early aspirin medication also showed an increasing trend year by year.However, even in 2011, there were still 2 hospitals （about 10%） with early aspirin use rate of less than 80% （55.6% and 69.2% respectively）. Multivariate Logistic analysis showed that patients with chest discomfort at admission （OR 4.6,5%CI 2.7-7.8） and PCI capacity hospitals （OR 3.2,5%CI 1.5-6.7） were more inclined to use aspirin, and non-ST-segment elevation myocardial infarction patients were less likely to use aspirin （OR 0.5,5%CI 0.3-0.8）. Conclusion From 2001 to 2011, the use rate of early aspirin in AMI hospitalized patients in rural areas of western China shows an obvious upward trend, but some hospitals and some characteristic populations still have a lot of room for improvement.