急性冠状动脉综合征患者出院时血管紧张素转换酶抑制剂及血管紧张素Ⅱ受体拮抗剂的使用情况分析

Use of angiotensin converting enzyme inhibitors and angiotensin Ⅱ receptor blockers in discharged patients with acute coronary syndrome

目的分析急性冠状动脉综合征患者(ACS)出院时血管紧张素转换酶抑制剂(ACEI)及血管紧张素Ⅱ受体拮抗剂(ARB)的使用情况。方法选择2015年1月至2017年1月在山西医科大学第二医院心内科住院的ACS患者602例,根据疾病特点将研究对象分为3组,即ST段抬高型心肌梗死组(A组)135例,非ST段抬高型心肌梗死组(B组)42例,无心肌梗死病史的不稳定型心绞痛组(C组)425例。回顾性分析3组患者出院时的ACEI/ARB类药物使用情况并进行比较。结果 602例患者出院时口服ACEI/ARB类药物共327例(54. 3%),其中口服ACEI类药物105例(17.4%),口服ARB类药物222例(36.9%),B、C组患者口服ACEI、ARB及ACEI/ARB比例均低于A组[19.0%(8/42)、13.4%(57/425)比29. 6%(40/135),28.6%(12/42)、35. 8%(152/425)比43. 0%(58/135),47. 6%(20/42)、49.2%(209/425)比72.6%(98/135)],差异均有统计学意义(均P <0. 05), B组与C组比较差异均无统计学意义(均P>0. 05)。结论出院ACS患者ACEI/ARB的使用率严重不足,其中ACEI的使用率更低,需进一步加强对ACEI/ARB在冠心病二级预防方面的认识,提高ACEI/ARB使用率。

Objective To analyze the use of angiotensin converting enzyme inhibitors（ACEI） and angiotensin Ⅱ receptor blockers（ARB） in patients with acute coronary syndrome（ACS） at discharge. Methods A total of 602 ACS patients were hospitalized between January 2015 and January 2017 in Second Hospital of Shanxi Medical University. According to the characteristics of disease, the patients were divided into 3 groups： ST-segment elevation myocardial infarction（group A, n=135）, non-ST-segment elevation myocardial infarction（group B, n=42） and unstable angina without myocardial infarction history（group C, n=425）. Usage of ACEI/ARB was analyzed in discharge medical records. Results Among 602 patients, the use rate of ACEI/ARB was 54.3%（n=327）; 105 patients took ACEI（17.4%）; 22 patients took ARB（36.9%）. Use rates of ACEI, ARB and ACEI/ARB in group B and C were significantly lower than those in group A[19.0%（8/42）, 13.4%（57/425） vs 29.6%（40/135）; 28.6%（12/42）, 35.8%（152/425） vs 43.0%（58/135）; 47.6%（20/42）, 49.2%（209/425） vs 72.6%（98/135）]（P〈0.05）; there was no significant difference between group B and C（P〉0.05）. Conclusion The use of ACEI/ARB, especially ACEI in discharged patients with ACS is not optimistic.