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目的:评估2001-2011年中国东部农村医院急性心肌梗死(AMI)患者住院期间他汀应用的变化趋势,并探讨其使用的影响因素。方法:采用两阶段随机抽样设计,抽取东部农村AMI患者代表性样本。第1阶段,采用简单随机抽样确定协作医院。第2阶段,选取2001、2006和2011年3个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,提取临床信息,计算院内他汀使用率。采用广义估计方程的多水平logistic回归模型分析影响他汀使用的因素。结果:共计32家医院2 926份AMI病历纳入研究。2001-2011年,AMI患者院内他汀使用率从2001年的15.48%增加到2006年的65.42%,和2011年的88.36%(趋势P值<0.001)。在3个研究年份中,整体而言,院内他汀的使用率随低密度脂蛋白胆固醇(LDL-C)水平的升高而增加,未测量LDLC的患者他汀使用率最低。多因素模型分析中,入院有胸痛(OR=2.11,95%CI:1.27~3.52,P=0.004)、合并高血压(OR=1.92;95%CI:1.28~2.86,P=0.001)更容易接受他汀治疗。相反,女性(OR=0.66,95%CI:0.44~0.99,P=0.044)、既往罹患出血性卒中(OR=0.39,95%CI:0.15~0.96,P=0.041)、冠心病患者(OR=0.46,95%CI:0.26~0.83,P=0.009)他汀使用率低于其他患者。结论:过去的10年间,我国东部农村AMI住院患者的他汀使用率大幅增长,指南对于他汀的推荐在临床实践中得到快速普及。但是,他汀应用仍然存在改善空间。
OBJECTIVE: To evaluate the trends of statin use in hospitalized patients with acute myocardial infarction (AMI) in rural hospitals in eastern China from 2001 to 2011 and to explore the influencing factors for their use. METHODS: A two-stage random sampling design was used to extract representative samples from AMI patients in rural eastern China. Phase 1, using simple random sampling to determine collaborative hospital. In the second stage, three specific years of 2001, 2006 and 2011 were selected. A systematic random sampling method was adopted in the collaborative hospital, and the medical records were extracted and the clinical information was extracted to calculate the statin utilization rate in the hospital. Multi-level logistic regression models using generalized estimation equations were used to analyze the factors that influence statin use. Results: A total of 2 926 AMI cases from 32 hospitals were included in the study. During 2001-2011, the rate of in-hospital statin use increased from 15.48% in 2001 to 65.42% in 2006 and 88.36% in 2011 (trend P value <0.001). Overall, in-hospital statin use increased with increasing levels of low-density lipoprotein cholesterol (LDL-C) during the three study years, with the lowest rate of statin use in non-LDLC patients. In the multivariate model analysis, chest pain (OR = 2.11, 95% CI: 1.27-3.52, P = 0.004) and admission to hypertension (OR = 1.92; 95% CI: 1.28-2.86, P = 0.001) were more likely to be accepted Statin treatment. In contrast, hemorrhagic stroke (OR = 0.39, 95% CI: 0.15-0.96, P = 0.041), coronary heart disease (OR = 0.66, 95% CI: 0.44-0.99, 0.46, 95% CI: 0.26-0.83, P = 0.009) statin use was lower than other patients. Conclusion: During the past 10 years, the statin use rate of inpatients with AMI in the rural areas of the eastern part of our country has greatly increased. The guidelines for statins are rapidly gaining popularity in clinical practice. However, there is still room for improvement in statin use.