上海市2063例急性心肌梗死患者住院治疗状况分析

A cross-sectional survey of treatment status of 2063 patients with acute myocardial infarction in Shanghai

目的 了解近两年上海市急性心肌梗死 (AMI)患者的住院治疗状况。方法 调查上海市 18所医院 2 0 0 0～ 2 0 0 1年出院诊断为AMI、住院时间 >2 4h患者的病史资料 ,调查内容包括各种中西医治疗措施应用情况。结果 共调查了 2 0 6 3例患者 ,其中男性占 70 8% ,住院期间年龄中位数为71 0岁。早期再灌注治疗率为 2 4 5 % ,其中 19 5 %接受溶栓治疗 ,4 9%接受直接经皮冠状动脉腔内成形术治疗。适宜溶栓率为 38 0 % ,适宜溶栓者中 4 0 6 %没有接受任何形式的早期再灌注治疗。β受体阻滞剂和血管紧张素转换酶抑制剂的适宜使用率分别为 73 3%和 90 9% ,实际使用率分别为4 5 1%和 72 7%。 38 5 %适宜使用 β受体阻滞剂和 2 0 0 %适宜使用血管紧张素转换酶抑制剂的患者没有得到相应的治疗。低分子肝素、阿司匹林、硝酸酯使用率较高 ,分别为 76 2 %、80 7%、92 4 %。他汀类药物的使用率也达到 5 0 5 %。超过半数AMI患者在上述治疗同时接受中医药治疗。结论 2 0 0 0～ 2 0 0 1年上海市AMI患者西医治疗情况与 1999年美国心血管病学会 美国心脏学会 (ACC AHA)治疗指南的要求存在差距 ;中医药的应用不少 ,但尚缺乏规范。

Objective To investigate the treatment status of hospitalized patients with acute myocardial infarction (AMI) in Shanghai. Methods The data of hospitalized patients with AMI discharged between January 2000 and December 2001 were retrospectively collected from medical records of 18 hospitals. All patients with a diagnosis of AMI and a length of hospital stay more than 24 hours were included in the study. We assessed both the use of western and traditional medicine. Results A total of 2063 patients were included. 70.8% of them were male, and the median age was 71.0 years. Reperfusion were performed in 24.5% of the patients, 19.5% received intravenous thrombolysis and 4.9% were treated with primary angioplasty. Of 738 thrombolysis-eligible patients, 300(40.6%) patients did not receive any reperfusion treatment. Among the patients, 73.3% were eligible for beta blockers (BB) and 90.9% for angiotensin-converting enzyme inhibitors (ACEI), but only 45.1% were actually treated with BB and 72.7% with ACEI. In other words, 38.5% BB eligible patients did not received BB and 20.0% ACEI eligible patients did not received ACEI. The utilization rates of low-molecular-weight heparin, aspirin, nitrates were relatively high,76.2%, 80.7%, 92.4% respectively. Up to 50.5% of the patients received statins. More than half of the patients with AMI received traditional medicine at the same time. Conclusions The ACC/ AHA guidelines recommended treatments are still under-utilized in patients with AMI in Shanghai. The traditional medicine are widely used, but still need to be standardized.