某医院急性ST段抬高型心肌梗死近十年诊疗趋势分析

Trend analysis of diagnosis and treatment of acute ST-segment elevation myocardial infarction in a hospital in the past 10 years

目的分析某医院急性ST段抬高型心肌梗死(STEMI)近十年的诊疗趋势。方法随机抽取2011年、2016年、2020年在驻马店市中心医院进行治疗并且出院的480例STEMI患者的住院病历(2011年100例、2016年160例、2020年220例),随后提取其临床相关信息,对STEMI患者临床特征、诊疗模式和结局进行分析。结果抽取驻马店中心医院480份STEMI患者病历。2011、2016及2020年,STEMI住院患者年龄呈上升趋势(P<0.05),高血压史、血脂异常史、吸烟史所占比例随时间推移升高(P<0.05),发病到入院时间、住院天数逐年缩短(P<0.05)。在无相应禁忌证患者中,2011、2016以及2020年总再灌注治疗率无明显变化(P=0.761),直接经皮冠状动脉介入术(PCI)比例由2011年的35.56%逐年增加至2020年的61.68%(P<0.05),溶栓治疗比例由2011年的31.11%逐年下降至2020年的7.48%(P<0.05)。院内用药中,阿司匹林24 h、氯吡格雷/替格瑞洛24 h、他汀类药物、血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体阻滞剂(ARB)、β受体阻滞剂≦24 h使用率均逐年增加(阿司匹林:2011年67.74%,2020年88.38%;氯吡格雷/替格瑞洛:2011年1.08%,2020年48.48%;他汀类药物:2011年2.83%,2020年74.51%;ACEI/ARB:2011年40.00%,2020年72.77%;β受体阻滞剂:2011年35.85%,2020年72.73%,均P<0.05)。院内检查中,肌钙蛋白、超声心动图检查率逐年升高(P<0.05)。2011、2016以及2020年,STEMI患者7 d内死亡率(2011年7.87%,2020年10.10%)、死亡+放弃治疗率(2011年11.24%,2020年13.64%)均无明显变化(P>0.05)。结论2011~2020年驻马店市中心医院急性STEMI患者的发病年龄以及高血压、血脂异常、吸烟所占比例升高,其再灌注治疗率无明显变化,同时院内二级预防药物使用率逐年增加,但STEMI患者结局并未得到改善。

Objective To investigate the diagnosis and treatment trends of acute ST-elevation myocardial infarction(STEMI)in a hospital in the past 10 years.Methods The medical records of 480 STEMI patients(100 cases in 2011,160 cases in 2016 and 220 cases in 2020)who were treated and discharged in Zhumadian Central Hospital in 2011,2016 and 2020 were randomly selected,and then the clinical related information was extracted to analyze the clinical characteristics,diagnosis and treatment mode and outcome of STEMI patients.Results In this study,480 STEMI patients’medical records were collected from Zhumadian central hospital.In 2011,2016 and 2020,the age of hospitalized patients with STEMI showed an upward trend(P<0.05),and the proportion of history of hypertension,dyslipidemia and smoking were significantly increased over time(P<0.05),and the time from onset to admission and hospitalization days decreased year by year(P<0.05).In the patients without corresponding contraindications,there was no significant change in the total reperfusion treatment rate in 2011,2016 and 2020(P=0.761).The proportion of direct percutaneous coronary intervention(PCI)increased year by year from 35.56%in 2011 to 61.68%in 2020(P<0.05),and the proportion of thrombolytic therapy decreased year by year from 31.11%in 2011 to 7.48%in 2020(P<0.05).The use rate of aspirin≤24 h,clopidogrel/ticagrelor≤24 h,statins,angiotensin converting enzyme inhibitor(ACEI)/angiotensinⅡreceptor blocker(ARB)βreceptor blocker≤24 h increased year by year(aspirin:67.74%in 2011,88.38%in 2020;clopidogrel/ticagrelor:1.08%in 2011 and 48.48%in 2020;statins:2.83%in 2011 and 74.51%in 2020;ACEI/ARB:40.00%in 2011 and 72.77%in 2020;βreceptor blockers:35.85%in 2011 and 72.73%in 2020,all P<0.05).In hospital examination,troponin and echocardiography examination rate increased year by year(P<0.05).In 2011,2016 and 2020,the mortality within 7 days(7.87%in 2011,10.10%in 2020)and the death+abandonment rate(11.24%in 2011,13.64%in 2020)of STEMI patients had no significant change(P>0.05).Conclusions From 2011 to 2020,the age of onset of acute STEMI patients in Zhumadian Central Hospital and the proportion of hypertension,dyslipidemia,and smoking increased,and their reperfusion treatment rate did not change significantly.At the same time,the use of secondary prevention drugs in the hospital increased year by year,but the ending of STEMI patients has not improved.