中国急性心肌梗死出院患者予以饮食建议／指导的情况及十年趋势调查

Trends study of diet consulting for discharged patients with acute myocardial infarction in China from 2001 to 2011

目的评价2001年1月至2011年12月间我国对急性心肌梗死（AMI）患者予以出院饮食建议／指导的情况及变化趋势。方法采用两阶段分层随机抽样，获得2001、2006和2011年具有全国代表性的AMI患者队列，并回顾性提取其住院临床资料。描述AMI出院予以饮食建议／指导的全国总体情况，高血压、糖尿病、高血脂等尤需注意饮食的患者中的情况，以及不同区域间情况。结果来自全国162家医院的16100份AMI病历被纳入研究。2001、2006、2011年，AMI患者出院时接受到饮食建议／指导的比例分别为16．5％、28．8％和40．8％（趋势P〈0．001）。高血压、高血脂、糖尿病三组的饮食建议／指导率及变化趋势均与总人群类似：高血压人群2001年16．4％，2006年31．4％，2011年41．1％；糖尿患者群2001年18．2％，2006年32．2％，2011年的42．8％；高血脂人群2001年18．6％，2006年31．4％，2011年41．5％（趋势P均〈0．001）。10年间，中部农村地区的饮食建议／指导率无明显变化（2001年19．2％，2006年19．4％，2011年22．8％；趋势P=0．09），而其他4个区域均呈上升趋势（趋势均P〈0．001）。结论2001—2011年间，我国AMI患者接受到出院饮食建议／指导率呈上升趋势，但仍存在巨大改善空间，中部农村地区尤甚。营养师应与临床医生密切配合，参与AMI患者的出院饮食指导，提高出院饮食建议／指导率，从而改善患者预后。

Objective To describe trends in diet consulting at discharge for patients with acute myocardial infarction （AMI） in China from 2001--2011. Methods A representative sample of patients in China admitted to hospital for AMI was created from a two-stage sampling approach ; profiles for patients with AMI were retrospectively abstracted through their medical records. The study described the overall trends in diet consulting for patients with AM1 in China, the rates of diet consulting among patients with hypertension, diabetes, and hyperlipidemia, and the variation in diet consulting across different regions. Results We sampled 162 hospitals and included 16 100 patients with AMI in total. The weighted rates of diet consulting at AMI discharge in China was 16. 5% , 28.8% , and 40. 8% in 2001, 2006 and 2011, respectively （P for trend 〈 0, 001 ）. The rates and trends among patients with hypertension, diabetes, and hyperlipidemia were similar to those among all patients with AMI （hypertension： 16.4%, 31.4% , and 41.1% in 2001, 2006 and 2011, respectively; diabetes： 18.2%, 32. 2% , and 42. 8% ; hyperlipidemia： 18.6%, 31.4%, and 41.5% ; all P for trend 〈 0. 001 ）. The rates has not changed much for those in central rural region over the decade （19.2%, 19.4%, and 22. 8% in 2001, 2006 and 2011, respectively; P for trend = 0.09）; meanwhile, the rates of diet consulting in other four regions increased over years （ all P for trend 〈 0. 001 ）.Conclusions From 2001 to 2011, the rates of diet consulting at discharge for patients with AMI has increased in China; however, there are still substantial rooms for improvement, especially for central rural region. Dietitian could work with clinician and be involved in diet consulting for AMI at discharge in order to improve prognosis for patients with AMI.