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目的:评估2001—2011年急性心肌梗死(acute myocardial infarction,AMI)住院患者中适宜使用β受体阻滞剂(β-blocker,βB)的人群在住院早期(入院24h内)使用βB的情况。方法:随机抽取辽宁省10家协作医院(均为三级医院)2001年、2006年、2011年诊断为AMI的住院患者,提取其临床信息,分析其中无βB禁忌症患者的相关情况,分析上述3年βB的使用率、种类和剂量。结果:入选的1 365例AMI患者中,296例(21.68%)为住院早期βB适宜人群(2001年、2006年、2011年分别为26例、57例、213例)。在适宜人群中βB使用率为2001年53.10%、2006年68.70%、2011年78.00%(P<0.001)。Logistic回归分析显示,心率与早期βB的使用有关。3年中,使用率最高的βB为美托洛尔(90.73%),但其剂量达到指南推荐的50mg以上者仅为1.46%。结论:2001—2011年辽宁省AMI患者适宜人群中住院早期βB的使用率呈逐年增长的趋势,但使用情况与指南推荐之间存在明显的差距。虽然早期βB应用可减少心血管事件的发生,但患者的心率等影响其应用,因此应遵循循证医学证据结合个体化原则早期应用。
PURPOSE: To evaluate the use of βB in early hospitalization (within 24 hours of admission) in a population of hospitalized patients with acute myocardial infarction (AMI) who are candidates for β-blocker (βB) during 2001-2011. Methods: Inpatients with AMI who were diagnosed as AMI in 2001, 2006 and 2011 in 10 cooperative hospitals in Liaoning Province were selected randomly, their clinical information was extracted and the cases without βB contraindications were analyzed. 3 years βB usage, type and dose. Results: Of the 1 365 AMI patients enrolled, 296 (21.68%) were eligible for early βB hospitalization (26 in 2001, 57 in 2006, and 213 in 2011). In the appropriate population βB utilization rate of 53.10% in 2001, 68.70% in 2006, 78.00% in 2011 (P <0.001). Logistic regression analysis showed that heart rate was related to the use of early βB. In the three years, the most commonly used betaB was metoprolol (90.73%), but only 1.46% of the doses were 50 mg or more recommended by the guidelines. CONCLUSIONS: The prevalence of early βB inpatients with AMI in Liaoning population tends to increase year by year from 2001 to 2011, but there is a clear gap between the usage and guidelines. Although the early application of βB can reduce the incidence of cardiovascular events, but the patient’s heart rate and its impact on its application, it should follow the evidence-based medicine combined with the principle of individual early application.