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目的评价2001—2011年中国东部农村急性心肌梗死(AMI)早期(入院24 h内)β受体阻滞剂的使用情况。方法两阶段随机抽样设计,选2001、2006和2011三个特定年份,抽取AMI病历,进行中心性病历信息提取。评价东部农村AMI患者β受体阻滞剂在入院24 h内的使用变化趋势及影响因素。结果抽样获取无β受体阻滞剂禁忌证的AMI病历1227份,其中584例早期使用β受体阻滞剂存在高休克风险,其余643例绝对适宜。2001、2006和2011年β受体阻滞剂早期使用绝对适宜人群的使用率分别为43.5%、62.3%和57.6%(趋势P=0.0944),而高休克风险的人群所占比例为35.3%、50.2%和51.9%(趋势P=0.0206)。年龄偏高、有慢性肺病史的患者较少接受早期β受体阻滞剂治疗;反之,就诊于教学医院的患者更易接受此治疗。结论 2001年至2011年我国东部农村地区AMI患者,适宜早期应用β受体阻滞剂的理想人群中,使用率明显不足,而具有高休克风险的患者仍在普遍使用。提示可作为AMI诊疗质量改善的一个靶点。
Objective To evaluate the use of β blockers early in 2001-2011 in rural AMI in China (within 24 h). Methods Two-stage random sampling design, selected 2001,2006 and 2011 three specific year, the AMI medical records, central medical records information extraction. Evaluation of the use of β blockers in AMI patients in eastern rural areas within 24 h of admission and the influencing factors. Results A total of 1227 AMI cases with no contraindications to β-blockers were obtained by sampling. Among them, 584 patients were at high risk of shock with early use of β-blockers, and the other 643 cases were absolutely suitable. The prevalence of β-blockers was 43.5%, 62.3% and 57.6%, respectively, for early use in 2001, 2006 and 2011 (trend P = 0.0944), and 35.3% for those at high risk of shock, 50.2% and 51.9% (trend P = 0.0206). Older patients with a history of chronic lung disease were less likely to receive early beta-blocker therapy; conversely, patients treated in teaching hospitals were more likely to receive this treatment. CONCLUSION: In 2001-2011, AMI patients in rural areas of eastern China were apparently under-utilized in the ideal population suitable for early use of β-blockers. Patients with high shock risk were still commonly used. Tips can be used as a quality target AMI clinic.