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目的为提高北京地区中医医院救治急性心肌梗死(AMI)水平而首次在国内进行中医医院AMI治疗情况的多中心临床流行病学调查。方法按中国中西医结合心血管病专业委员会统一调查表,选择北京地区5家三级甲等中医医院的400例AMI患者,对其发病特点、再灌注和中西药物治疗及病死率进行调查,以《急性心肌梗死诊断和治疗指南》(简称《指南》)为评价依据对住院治疗状况进行分析。结果400例AMI患者平均年龄(66.62±11.91)岁,男女比例为1.58∶1。中医辨证标实证中血瘀证372例(93%),所占比例最多,痰阻者212例(53%);本虚证中以气虚最多见,占本虚证的59.25%,其次为阴虚占27.25%。总病死率为13.31%。与文献资料比,中医医院住院患者年龄大、女性比例相对大、伴随疾病多、合并证多、病情重、病死率高。静脉溶栓病例占全部观察病例数的23.50%,总再灌注率24.5%;硝酸酯类药使用率95.5%,肝素89.5%,阿司匹林83.29%,β受体阻滞剂63.5%,血管紧张素转化酶抑制剂65.8%,调脂药33.0%。静脉中药治疗中活血化瘀类品种和使用例数略多于补气类药物,中药煎剂中活血药多于化痰、补气药物。结论中医医院AMI患者具有相对独立的临床特征,中医证候以血瘀、痰阻、气虚、阴虚证为主。治疗情况在遵循《指南》方面尚存在一定差距,中药活血药具有重要的治疗地位。采用综合的治疗手段,包括再灌注治疗和发挥中医药特色等,进一步降低中医医院治疗AMI的病死率是我们面临的课题。
Objective To investigate the multi-center clinical epidemiological investigation of AMI treatment in Chinese medicine hospitals for the first time in order to improve the level of acute myocardial infarction (AMI) in Chinese medicine hospitals in Beijing. Methods According to the unified questionnaire of Chinese Integrative Medicine Cardiovascular Diseases Commission, 400 AMI patients from 5 tertiary Chinese medicine hospitals in Beijing area were selected to investigate the characteristics of their disease, reperfusion, Chinese and Western medicine treatment and case fatality rate. The Guidelines for the Diagnosis and Treatment of Acute Myocardial Infarction (the “Guide”) analyze the status of hospitalizations for evaluation. Results The average age of 400 patients with AMI (66.62 ± 11.91) years, male to female ratio was 1.58: 1. There were 372 cases (93%) of syndromes of blood stasis syndrome in traditional Chinese medicine syndrome differentiation syndrome, accounting for the largest proportion and 212 cases (53%) of phlegm obstruction. Among the deficiency syndromes, qi deficiency was the most common, accounting for 59.25% of the deficiency syndrome, followed by Yin Makes up 27.25%. The total case fatality rate was 13.31%. Compared with the literature, Chinese hospital inpatients are older, the proportion of women is relatively large, with more diseases, multiple mergers, serious illness, high mortality. The cases of intravenous thrombolysis accounted for 23.50% of the total observed cases and the total reperfusion rate was 24.5%. The rates of using nitrates were 95.5%, heparin 89.5%, aspirin 83.29%, β-blockers 63.5% and angiotensin II 65.8% enzyme inhibitors, lipid-lowering drugs 33.0%. Chinese medicine treatment of blood circulation and blood stasis type of species and the number of cases slightly more than qi-class drugs, Chinese medicine decoction of blood more than phlegm, invigorating drugs. Conclusions AMI patients in TCM hospitals have relatively independent clinical features. TCM syndromes mainly include blood stasis, phlegm resistance, qi deficiency and yin deficiency. Treatment follow the “guidelines” there is still a certain gap, traditional Chinese medicine Huoxue medicine has an important therapeutic position. Adopting comprehensive treatment methods, including reperfusion therapy and exerting the characteristics of traditional Chinese medicine, further reduce the mortality rate of AMI in Chinese medicine hospitals is the subject we are facing.