中国急性心肌梗死出院患者生活方式改善建议的情况及十年趋势

10-year Trend of Lifestyle Changing Instruction for Acute Myocardial Infarction Patients at Discharge in China

目的:评价2001~2011年间我国医生对急性心肌梗死(AMI)出院患者予以生活方式改善建议的情况及变化趋势。方法:研究使用具有全国代表性的China PEACE回顾性AMI研究数据,根据患者出院接受的生活方式改善建议条目数,将其分为0条建议组、1~2条建议组和3~5条建议组,描述各组比例及十年趋势,以及五个区域(东部城市、中西部城市、东部农村、中部农村、西部农村)未予以任何建议的情况;此外,报告具体各项(饮食、运动、血脂评估、戒烟、控制体重共五条建议)的建议率及十年趋势。结果:研究共纳入全国162家医院的16 100份AMI病历。2001年、2006年、2011年,AMI出院未接受任何建议的比例分别为76.6%,65.7%和54.4%(P_(trend)<0.001);接受到1~2条建议者从2001年的23.2%逐渐升至2011年的42.9%(P_(trend)<0.001);2011年接受到3~5条建议的比例为2.7%。2011年,五个区域未接受到任何建议的比例从47.1%到69.5%不等;十年间,中部农村、西部农村未接受到任何建议的比例无明显变化(P_(trend)分别为0.11和0.10),余三个区域则呈下降趋势(P_(trend)均<0.001)。单独各条生活方式改善的建议率随年份上升:饮食的建议率在2001年为16.6%,2006年为27.8%,2011年为38.3%(P_(trend)<0.001);三年的运动建议率分别为9.2%、10.9%、14.3%(P_(trend)<0.001);血脂评估建议率和戒烟建议率分别从2001年的0.9%和2.2%,升至2011年11.9%和8.8%(P_(trend)均<0.001);而控制体重的建议率在十年间无明显变化,2011年在体重指数≥24 kg/m2的人群中为1.3%(P_(trend)=0.32)。结论:2001~2011年十年间,我国医生对AMI出院患者进行生活方式改善建议率有所上升,但总体仍严重不足,亟待改善。应强调对AMI出院患者进行生活方式改善建议的重要性,通过提高相应建议率切实改善患者预后。

Objective： To assess the trend of lifestyle changing instruction for acute myocardial infarction（AMI） patients at discharge in China from 2001-2011.Methods： Based on national representative data of China PEACE retrospective AMI study and the number of instructions AMI patients received at discharge, our research was classified into 3 groups： no instruction group,（1-2） instructions group and（3-5） instructions group. We described the instruction rates in different groups with 10-year trend and no instruction status in 5 regions of eastern urban, central/western urban, eastern rural, central rural, and western rural. In addition, we reported the instruction rates of diet consulting, exercise consulting, blood lipid evaluation, smoking cessation, and weight control with 10-year trend.Results： A total of 16100 medical records of AMI from 162 hospitals were enrolled. No instruction rates at discharge were 76.6%, 65.7% and 54.4% in 2001, 2006 and 2011, respectively, P_（trend）0.001. The proportion for receiving（1-2） instruction（s） at discharge increased from 23.2% in 2001 to 42.9% in 2011, P_（trend）0.001; the rate for receiving（3-5） instructions was 2.7% in 2011.No instruction rates in 5 regions were from 47.1% to 69.5%; no instruction rates in central and western rural regions had little changes during the 10-year period, P_（trend）=0.11 and P_（trend）=0.10, respectively; no instruction rates in the rest 3 regions showed decreasing trend, all P_（trend）〈0.001. Most of the single instruction rates for lifestyle changing increased from 2001 to 2011, diet consulting were 16.6%, 27.8%, and 38.3% respectively, P_（trend）〈0.001; exercise consulting were 9.2%, 10.9% and 14.3% respectively, P_（trend）〈0.001; from 2001 to 2011, blood lipids evaluation was increased from 0.9% to 11.9%; smoking cessation increased from 2.2% to 8.8%, both P_（trend）〈0.001; however the weight control rate was 1.3% in 2011, which was had little change within 10 years, P_（trend）=0.32.Conclusion： The rate of lifestyle changing instruction for AMI patients at discharge was increasing from 2001-2011, however, it was still insufficient and should be emphasized to improve the prognosis of AMI patients in China.