二级医院急性冠状动脉综合征治疗现状与指南的差距

摘要

目的:了解二级医院急性冠状动脉综合征(ACS)治疗现状与指南的差距.方法:对119例ACS患者的治疗情况进行回顾性分析,其中64例为ST段抬高型心肌梗死(STEMI组),55例为非ST段抬高型心肌梗死或不稳定型心绞痛(NSTEMI/UAP组).结果:STEMI组中,18例行尿激酶静脉溶栓治疗,NSTEMI/UAP组住院期间未进行任何再灌注治疗;23例住院稳定后转院择期经皮冠状动脉介入治疗,其中STEMI组与NSTEMI/UAP组分别为29.7%和7.3%.在STEMI组与NSTEMI/UAP组中使用阿司匹林分别为98.4%和98.2%,氯吡格雷92.2%和67.3%,血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂73.4%和83.6%,他汀类调脂药98.4%和92.7%,β受体阻滞剂60.9%和78.2%,低分子量肝素(LMWH)93.8%和72.7%,硝酸酯类药82.8%和94.5%,钙离子拮抗剂0.3%和12.7%,中成药82.8%和90.9%;2组比较,STEMI组中氯吡格雷和LMWH及再灌注治疗高于NSTEMI/UAP组(P<0.01),而β受体阻滞剂少于NSTEMI/UAP组(P<0.05).结论:在基层二级医院治疗ACS中,治疗STEMI执行指南比NSTEMI/UAP要好,二者仍有一定的提升空间.%Objective :To explore the disparity between the treatment of different types of acute coronary syndrome( ACS ) in the basic secondary hospital and the guidelines. Methods : A retrospective analysis was performed on 119 ACS patients. Among them ,64 suffered from ST-segment elevation myocardial infarction( STEMI ) and 55 non-ST elevation myocardial infarction( NSTEMI ) or unstable angina pectoris( UAP ). Results : Among the 64 cases of STEMI, 18 received urokinase thrombolytic therapy;23 patients in the STEMI group ( 29.7％ ) and NSTEMI/UAP group( 7. 3％ ) were transferred to other hospitals to receive percutaneous coronary intervention( PCI ) treatment( 35.9％ )when in stable condition. The difference was significant. Among the patients in STEMI group and NSTEMI/UAP group 98. 4％ and 98. 2％ were respectively administered Aspirin, 92. 2％ and 67. 3％ clopidogrel,73. 4％ and 83. 6％ angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor antagonist,98. 4％ and 92. 7％ statins,60. 9％ and 78. 2％ β receptor blockers, 93.8％ and 72.7％ low molecular weight heparin( LMWH ),82. 8％ and 94. 5％ nitrate drug,0. 3％ and 12. 7％ calcium channel blockers( CCB ) ,and 82. 8％ and 90. 9％ Chinese medicine. The clopidogrel, LMWH and reperfusion therapy were more often used in the STEMI group than in the NSTEMI/UAP group( P ＜ 0. 01 ), while β-blocker and nitrate drugs were less used( P ＜ 0. 05 ). Conclusions : The guidelines are hetter implemented in management of STEMI than that of NSTEMI/UAP in basic secondary hospitals. There are still chances to improve.