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背景急性心肌梗死(AMI)在我国发病率及死亡率居高不下,阿司匹林早期使用可明确降低死亡风险,指南推荐无禁忌症患者尽早服用。评价农村地区AMI患者早期阿司匹林的使用情况及影响因素将有利于改善医疗质量。目的评价2001-2011年东部农村AMI患者入院24小时内阿司匹林使用率及变化趋势,并分析可能影响其早期使用的因素。方法采用两阶段随机抽样设计获取2001、2006和2011三个特定年份的AMI病历,提取病历信息。分析阿司匹林在入院24小时内的三个年度的加权使用率及各医院的变化趋势,并通过logistic回归方法分析其使用的影响因素。结果抽取东部农村32家医院参加研究,随机抽样获得2001、2006和2011年无阿司匹林禁忌症的AMI住院病历共2785份。2001、2006及2011年的加权使用率分别为79.1%,78.3%和86.4%(趋势P<0.001)。医院间使用差异逐渐缩小。住在教学医院,或有高血压病史、有胸部不适症状、接受溶栓治疗的患者阿司匹林服用比例相对高;反之,高龄或合并心源性休克的患者较少接受早期阿司匹林治疗。结论东部农村地区AMI住院患者早期阿司匹林使用率2001-2011年呈上升趋势,医院间差异缩小,改善明显。
Background Acute myocardial infarction (AMI) in China morbidity and mortality high, early use of aspirin can clearly reduce the risk of death, the guidelines recommend patients without contraindications as soon as possible. Evaluating the use and influencing factors of early aspirin in AMI patients in rural areas will improve the quality of medical care. Objective To evaluate the aspirin utilization rate and its change trend within 24 hours from January 2001 to January 2011 in rural AMI patients in east China and to analyze the factors that may affect its early use. Methods The two-stage random sampling design was used to obtain the records of AMI in three specific years of 2001, 2006 and 2011, and the medical history information was extracted. We analyzed the weighted utilization rate of aspirin in three years within 24 hours of admission and the trend of each hospital, and analyzed the influencing factors of its use by logistic regression method. Results A total of 2 785 AMI medical records of aspirin-free contraindications in 2001, 2006 and 2011 were collected randomly from 32 hospitals in rural areas of eastern China. The weighted utilization rates in 2001, 2006 and 2011 were 79.1%, 78.3% and 86.4% respectively (trend P <0.001). Differences between hospitals gradually narrowed. Living in teaching hospitals, or have a history of hypertension, chest discomfort, patients receiving thrombolytic therapy aspirin relatively high proportion; the other hand, elderly or patients with cardiogenic shock less early aspirin treatment. Conclusion The incidence of early aspirin inpatients with AMI in eastern rural areas tends to increase in the period from 2001 to 2011, with the difference between hospitals narrowing and improving obviously.