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目的:了解中国心血管病医生对急性冠状动脉综合征(ACS)诊疗的观点,评估目前中国ACS急性期诊治及二级预防治疗的模式。方法:在全国范围内选取代表性医院,于2010-04-2010-08期间向各医院负责ACS诊疗的科室的负责医生邮寄统一的调查问卷,了解其对ACS急性期及二级预防诊疗的观点,并进行描述和统计分析。结果:共发放问卷1 389份,回收1 009份(73%)。调查显示,肌酸激酶同工酶和(或)肌钙蛋白是绝大多数被调查医生选用的急性期心肌损伤标记物。对急性ST段抬高型心肌梗死的再灌注治疗,三级医院中51%首选急诊经皮冠状动脉介入术,而二级医院中82%首选静脉溶栓治疗。87%以上的医生认为抗血小板治疗、抗凝治疗、他汀类药物、β-受体阻滞剂、血管紧张素转化酶抑制剂和硝酸酯类药物是ACS急性期的常规治疗药物。一些指南不推荐的药物(如钙离子拮抗剂、硫酸镁制剂及极化液)仍被部分医生常规使用。在二级预防方面,85%以上的医生认为应给予患者抗血小板治疗、他汀类药物、β-受体阻滞剂和血管紧张素转化酶抑制剂。结论:目前中国大中型医院的心血管病医生对于ACS急性期诊治及二级预防治疗模式的观点与指南基本吻合,但仍有待改进之处。
OBJECTIVE: To understand the views of Chinese cardiovascular doctors on the diagnosis and treatment of acute coronary syndrome (ACS) and to evaluate the current modes of acute diagnosis and treatment and secondary prevention and treatment of ACS in China. Methods: A representative hospital was selected across the country. During the period of 2010-04-2010-08, a unified questionnaire was sent to responsible doctors of departments responsible for ACS diagnosis and treatment in hospitals to find out their opinions on acute and secondary prevention and treatment of ACS , And describe and statistical analysis. Results: A total of 1 389 questionnaires were sent out and 1 009 copies (73%) were recovered. Surveys show that creatine kinase isoenzyme and / or troponin are the most commonly used markers of acute myocardial injury selected by investigators. For acute STEMI reperfusion therapy, 51% of first-rate hospitals in tertiary hospitals prefer primary percutaneous coronary intervention, whereas 82% of secondary hospitals prefer intravenous thrombolysis. More than 87% of physicians believe that antiplatelet therapy, anticoagulant therapy, statins, beta-blockers, angiotensin converting enzyme inhibitors and nitrates are routine therapies for acute ACS. Some guidelines do not recommend the use of drugs (such as calcium antagonists, magnesium sulfate preparations and polarization solution) is still some doctors routine use. In secondary prevention, more than 85% of doctors believe that patients should be given antiplatelet therapy, statins, beta-blockers and angiotensin-converting enzyme inhibitors. Conclusion: At present, the viewpoints of cardiologists in large and medium-sized hospitals in China on the diagnosis, treatment and secondary prevention and treatment mode of ACS are consistent with the guidelines, but there is still room for improvement.