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目的:评价2001~(-2)011年中国西部农村地区急性心肌梗死(AMI)患者血管紧张素转化酶抑制剂和血管紧张素受体阻滞剂(ACEI/ARB)的使用情况及影响因素。方法:采用China PEACE回顾性AMI研究的数据,通过两阶段随机抽样获得2001、2006和2011年有代表性的西部农村AMI患者的临床信息。为估算出3个研究年份ACEI/ARB的使用率和变化趋势,对每年度的数据分别进行加权计算,以代表西部农村整体情况。采用二元logistic回归方法分析其使用的影响因素。结果:32家西部农村医院参加研究,入选999份AMI病例,其中中国指南Ⅰ类推荐组967例,Ⅱa类推荐组32例。2001、2006和2011年,指南Ⅰ类推荐患者ACEI/ARB加权使用率分别为56.1%、62.5%和67.6%,有明显改善(趋势P值=0.01);指南Ⅱa类推荐患者为41.1%、28.9%和49.3%,无明显改善(趋势P值=0.59)。在3个研究年份中,ACEIs使用率均显著高于ARBs。多因素分析显示,吸烟(OR:1.43,95%CI:1.09~1.88)、合并高血压(OR:2.84,95%CI:2.08~3.89)和心力衰竭(OR:1.91,95%CI:1.25~2.94)的患者更倾向于使用ACEI/ARB。相反,非ST段抬高型心肌梗死(OR:0.45,95%CI:0.29~0.70)、估计肾小球滤过滤(eGFR)<60ml·min~(-1)·1.73m~(-2)(OR:0.52,95%CI:0.29~0.94)和eGFR 60~89ml·min~(-1)·1.73m~(-2)(OR:0.59,95%CI:0.41~0.86)的患者较少使用ACEI/ARB。结论:2001~(-2)011年,我国西部农村地区指南Ⅰ类推荐的AMI患者中ACEI/ARB整体使用率呈明显上升趋势,但仍有较大的改善空间。亟待采取针对性的质量改善措施将循证医学证据及时准确地应用到临床实践中,以改善患者预后。
OBJECTIVE: To evaluate the use and influencing factors of angiotensin-converting enzyme inhibitors and angiotensin-converting enzyme blockade (ACEI / ARB) in patients with acute myocardial infarction (AMI) in rural areas of western China from 2001 to (-2) Methods: Based on the data from China PEACE retrospective AMI study, we obtained the clinical information of representative AMI patients in Western China in 2001, 2006 and 2011 by two-stage random sampling. To estimate the usage and trends of ACEI / ARB during the three study years, the annual data were weighted separately to represent the overall situation in western rural areas. Binary logistic regression analysis was used to analyze the influential factors. Results: Thirty-two western rural hospitals participated in the study, and 999 AMI cases were enrolled. Among them, 967 were recommended in Chinese Class I and 32 in Class IIa. In 2001, 2006 and 2011, the weighted average of ACEI / ARB was 56.1%, 62.5% and 67.6% respectively in class Ⅰ, and the improvement was significant (trend P = 0.01); Class Ⅱa recommended guidelines were 41.1% and 28.9 % And 49.3%, no significant improvement (trend P value = 0.59). ACEIs utilization rates were significantly higher than ARBs in three study years. Multivariate analysis showed that smoking (OR: 1.43, 95% CI: 1.09-1.88), hypertension (OR: 2.84, 95% CI: 2.08-3.89) and heart failure 2.94) were more likely to use ACEI / ARB. In contrast, noninflammatory myocardial infarction (OR: 0.45, 95% CI: 0.29 to 0.70) was estimated to have an estimated glomerular filtration rate (eGFR) <60 ml · min -1 · 1.73 m -2 (OR: 0.52, 95% CI: 0.29-0.94) and eGFR 60-89ml · min -1 (1.73m -2 OR (0.59,95% CI 0.41-0.86 Use ACEI / ARB. CONCLUSION: From 2001 to (-2) 011, the overall utilization rate of ACEI / ARB in class Ⅰ AMI patients in rural areas in western China showed a significant upward trend, but there was still room for improvement. Urgent need to take targeted quality improvement measures evidence-based medical evidence timely and accurate application to clinical practice, to improve patient prognosis.