血管紧张素转换酶抑制剂在心肌梗死合并糖尿病患者中使用情况调查

An Investigation of Angiotensin-Converting Enzyme Inhibitior in the Treatment of Diabetic Patients With Myocardial Infarction

目的 :调查太原地区五所医院 1999年～ 2 0 0 2年 4个年度心肌梗死并糖尿病 2 48例住院患者血管紧张素转换酶抑制剂 (ACEI)的应用情况 ,为临床实践提供资料。方法 :2 48例患者采用回顾性病史分析方法 ,按年度进行统计对比。分析内容包括ACEI的使用率、使用剂量以及影响其使用的因素。结果 :①ACEI 4年的平均使用率为 61 69% ,使用禁忌率为 3 2 3 %。排除使用禁忌后 4年的平均使用率为63 75 % ,4个年度依次为 5 6 82 %、66 15 %、63 49%、66 18% (P >0 0 5 )。②ACEI的应用种类多样 ,其中卡托普利应用最多 ,占 45 10 % ;ACEI的使用剂量普遍偏低 ,以卡托普利为例 ,每日用量为 (3 6 0 6± 2 9 5 6)mg。③logistic回归分析结果显示 ,影响ACEI使用的因素有心肌梗死部位、是否合并高血压及心功能情况 (OR值分别为 0 5 2 6、0 5 5 1、2 5 68) ;非前壁心肌梗死、血压正常、心功能正常及NYHAⅠ、Ⅱ级的心肌梗死患者较少接受ACEI的治疗。结论 :近年来ACEI在心肌梗死并糖尿病患者中的应用呈较普遍趋势 ,但仍有一些因素限制了ACEI的使用 ,使部分高危患者未能从应用该药中获益 ,而且应用该药的患者中 ,ACEI的剂量普遍不足 ,在今后的临床实践中需引起重视。

Objective: To investigate angiotensin-converting enzyme inhibitior (ACEI) treatment for hospitalized diabetic patients with myocardial infarction in five hospitals of Taiyuan during the years of 1999,2000,2001 and 2002,and provide data for clinical practice.Methods: In-hospital case records of diabetic patients with myocardial infarction during these four years were analysed and compared. Results: ①Out of all the patients,61.69% received ACEI treatment after hospital discharge in the four years.Contraindications to ACEI were present in 3.23% of all patients.Except the patients with contraindications to ACEI,63.75% patients received this treatment.The yearly average percentage of patients receiving ACEI with no contraindications was 56.82%,66.15%,63.49% and 66.18%( p >0.05),respectively. ②Several kinds of ACEI were used and the mean daily dosage of ACEI was lower than expected.The dosage of captopril was(22.50±13.24),(24.69±12.58),(56.56±39.71) and(32.92±24.49)mg( p <0.01)during the four years,respectively. ③Factors that influence the prescription of ACEI in diabetic patients with myocardial infarction were zone of myocardial infarction,hypertention and congestive heart failure (odds ratio 0.526,0.551,and 2.568,respectively).ACEI was not commonly used in patients without anterior MI,hypertention or severe heart failure.Conclusion: Although there are common trends towards using ACEI in diabetic patients with myocardial infarction in recent years,some factors still influence the usage of ACEI in these high risk patients.In most cases ACEI was not given in sufficient doses,to which attention should be paid in the clinical practice.