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目的:评价2006-2011年中西部城市地区急性心肌梗死(AMI)患者住院早期氯吡格雷的使用率及变化情况,并探讨影响其使用的因素。方法:采用两阶段随机抽样方法抽取2006年和2011年两个年份的AMI患者病历,提取临床信息,评估入院24h内氯吡格雷的应用情况。采用广义估计方程的多水平logistic回归模型分析影响因素。每年度分别进行加权计算,以代表中西部城市地区整体情况。结果:中西部城市共计32家医院的2 723份AMI病历纳入研究。中位年龄为63岁,女性患者占26.3%。2006-2011年,AMI患者住院早期氯吡格雷使用率从54.2%增加到87.7%(P<0.01)。分析早期氯吡格雷使用的影响因素:入院有胸部不适、ST段抬高型心肌梗死、院内接受溶栓以及PCI患者更易接受氯吡格雷治疗,相反,年龄≥65岁、入院时收缩压≥180mmHg(1mmHg=0.133kPa)或舒张压≥110mmHg患者氯吡格雷使用率低于其他患者。结论:过去6年间,我国中西部城市地区AMI患者住院早期氯吡格雷应用得到显著改善,但仍然有改善空间。
PURPOSE: To evaluate the prevalence and changes of early-stage use of clopidogrel in hospitalized patients with acute myocardial infarction (AMI) in central and western urban areas from 2006 to 2011 and to explore the factors influencing their use. Methods: Two-stage random sampling method was used to collect the records of patients with AMI in two years from 2006 to 2011. The clinical information was extracted and the application of clopidogrel within 24 hours after admission was evaluated. Multi-level logistic regression model of generalized estimating equation was used to analyze the influencing factors. Each year weighed separately to represent the overall situation in the central and western urban areas. Results: A total of 2 723 AMI cases from 32 hospitals in central and western cities were included in the study. The median age was 63 years and women were 26.3%. In 2006-2011, the rate of early use of clopidogrel in hospitalized patients with AMI increased from 54.2% to 87.7% (P <0.01). Analysis of the influencing factors of early use of clopidogrel: chest discomfort admitted on admission, ST-segment elevation MI, intra-hospital thrombolysis, and PCI were more likely to be treated with clopidogrel. Conversely, patients aged 65 years or older had a systolic blood pressure of ≥180 mm Hg (1mmHg = 0.133kPa) or diastolic blood pressure ≥ 110mmHg clopidogrel in patients with lower than other patients. Conclusion: In the past 6 years, the application of early-stage clopidogrel in AMI patients in urban areas in central and western China has been significantly improved, but there is still room for improvement.