论文部分内容阅读
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 the application of angiotensin converting enzyme inhibitor (ACEI) in 48 inpatients with myocardial infarction and diabetes mellitus in five hospitals in Taiyuan from 1999 to 2002, and provide information for clinical practice. Methods: Twenty-eight patients underwent retrospective medical history analysis, and compared them according to the annual statistics. Analyzes include the rate of use of ACE inhibitors, the dose used, and the factors that affect their use. Results: ① The average utilization rate of ACE in 4 years was 61 69%, and the taboo rate of use was 32.3%. The average utilization rate of 4 years after exclusion of contraindications was 63 75%, followed by 5 6 82%, 66 15%, 63 49% and 66 18% in 4 years (P 0 05). (2) There are many kinds of applications of ACE, of which captopril is the most widely used, accounting for 45 10%. The dosage of ACEI is generally low. Taking captopril as an example, daily dosage is (3660 ± 2965) mg. ③Logistic regression analysis showed that the factors influencing the use of ACEI were myocardial infarction, hypertension and cardiac function (OR values: 0 5 2 6, 0 5 5 1, 2 5 68 respectively); non anterior myocardial infarction, Normal blood pressure, normal cardiac function and NYHA Ⅰ, Ⅱ grade myocardial infarction patients less ACEI treatment. Conclusion: In recent years, the application of ACEI in patients with myocardial infarction and diabetes mellitus tends to be more common. However, there are still some factors that restrict the use of ACEI and make some high-risk patients fail to benefit from the application of this medicine. In addition, In general, the dose of ACEI generally inadequate, in the future clinical practice needs attention.