辽北贫困地区急性ST段抬高型心肌梗死二级预防用药情况及对策分析

摘要

目的 了解辽宁北部贫困地区急性ST段抬高心肌梗死(STEMI)患者的治疗现状及二级预防用药情况,初步探讨可能的改进措施.方法 连续入选2014年1月-2016年12月因胸痛就诊于辽北地区7家县医院的STEMI患者635例,详细记录患者的二级预防用药情况及临床资料.结果 635例患者中,服用阿司匹林475例(74.8％),氯吡格雷212例(33.4％),血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB) 280例(44.1％),β受体阻滞剂178例(28.0％),他汀类药物429例(67.6％),低分子肝素134例(21.1％).行心脏超声检查116例(18.3％).院内接受再灌注治疗140例(22.0％),其中溶栓25例(3.9％),院内择期PCI 115例(18.1％);转院接受PCI治疗120例(18.9％),患者住院期间病死率为8.8％(56/635),放弃治疗自行出院134例(21.1％).患者平均住院费用为8 548.9元,平均住院时长为8.3d.院内共发生心力衰竭92例(14.5％),急性心肌再梗死68例(10.7％),各种恶性心律失常118例(18.6％),心源性死亡56例(8.8％),脑出血和脑缺血性卒中17例(2.7％),严重消化道出血事件14例(2.2％).结论 辽宁北部贫困地区二级预防用药普遍偏低,接受心脏超声检查比例及再灌注治疗比例极低,应提高基层医院对急性心肌梗死(AMI)的救治能力,提高基于指南的二级预防用药比例,建立合理的AMI救治三级医疗体系,从而提高STEMI救治能力,改善预后.%Objective To investigate the present treatment status and second level drug prevention of acute STEMI in the poor areas of northern Liaoning and to explore the possible measures for improvement.Methods Seven county hospitals in poor areas of northern Liaoning Province and 635 cases of STEMI patients were included in this study.Second level drug prevention and clinical data were recorded in detail.Results Aspirin were 475 (74.8％) and clopidogrel were 212 (33.4％),angiotensin converting enzyme inhibitors / angiotensin Ⅱ receptor antagonist (ACEI/ARB)were 280 (44.1％),beta blockers were 178(28.0％),statins were 429(67.6％) and low molecular weight heparin were 134(21.1％).The proportion of echocardiography examination was 116(18.3％).140(22.0％)of the STEMI patients received reperfusion therapy,25 (3.9％)of the patients received thrombolysis,elective PCI ratio was 115(18.1％),patients transferred for PCI was 120(18.9％),in hospital mortality rate was 56(8.8％),give up for treatm.ent was 134(21.1％).The average hospitalization cost was RMB 8 548.9,and the mean hospitalization time was 8.3 days.Conclusion The second level drug prevention of acute STEMI in poor areas of northern Liaoning Province was generally low,the echocardiography examination and the ratio of reperfusion therapy was really low.It is necessary to enhance the diagnosis and treatment ability of AMI,improve the second level drug prevention and establish the three level diagnosis and treatment system in northern Liaoning Province,which will Improve STEMI treatment ability and prognosis.