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我国住院急性冠状动脉综合征患者合并多重危险因素及临床治疗现状

The prevalence of risk factors and status of clinical practice patterns among hospitalized patients with acute coronary syndromes

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目的 分析我国住院急性冠状动脉综合征患者多重危险因素的分布特点和指南推荐药物使用的现状及影响因素.方法 为多中心横断面研究,全国22个省、市、自治区的34家协作医院参加.从2012年4月15日起,各协作医院连续入选符合标准的住院冠心病患者≥90例.资料完整用于此次分析的病例共3 253例.结果 (1)住院冠心病患者平均年龄男性小于女性(60.4岁比66.2岁,P<0.01).近60%的患者<65岁.男性有约1/3患者(<55岁),女性有2/5患者(<65岁)为早发冠心病病例.(2)高血压、高脂血症、吸烟和糖尿病4个主要危险因素中以合并高血压患病率最高,为68.4%.90%以上的患者合并有≥1项危险因素,其中约2/3的患者合并有≥2项危险因素.(3)指南推荐药物应用情况:阿司匹林使用率最高,达到了95.3%;其次为他汀类药物,为90.1%,最低的是血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB),为53.6%.多因素分析显示,与住院期间未接受经皮冠状动脉介入治疗(PCI)患者相比,接受PCI者ACEI或ARB和β受体阻滞剂使用率提高30%以上,他汀类药物的使用率提高50%以上,抗血小板药物的使用率提高了4~7倍.结论 我国90%以上的住院冠心病患者合并有≥1个主要心血管病危险因素.指南推荐应用的药物仍有改善余地.应加强对未行PCI的冠心病患者指南推荐药物的应用.

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Objective To analyze the distribution of multiple risk factors for hospitalized patients with acute coronary syndromes (ACS) and explore the status and determinants of drug usage recommended by the guideline.Methods This was a multi-center cross-sectional study in 34 hospitals from 22 provinces in China.About ninety ACS patients were consecutively enrolled from each hospital since April 15,2012 according to a standard protocol.Totally,3 253 patients with complete data were analyzed in this study.Results (1) The average age of male patients with ACS was lower than that of female patients (60.4 years vs 66.2 years,P <0.01).Nearly 60% of ACS patients were under the age of 65 years.Early onset of ACS accounted for one-third of male (< 55 years of age) and two-fifthes of female patients (< 65 years old).(2) Among the four ACS major risk factors (hypertension,hyperlipidemia,smoking and diabetes),hypertension was with the highest prevalence (68.4%).More than 90% of ACS patients had at least one risk factor and about two-thirds of them had at least two.(3) As for the application of evidence-based drugs,the top one was aspirin with 95.3% of ACS patients reseiving it.The second was statins (90.1%).Angiotensin converting enzyme inhibitors (ACEI) or angiotension Ⅱ receptor blocker(ARB) was the lowest (53.6%).Multivariable analysis indicated that,in contrast to that in ACS patients without percutaneous coronary intervention(PCI),the drug usage rates were increased by more than 30% for ACEI or ARB and β receptor blockers,by more than 50% for statins,and by 4-7 times for antiplatelet agents among ACS patients with PCI.Conclusions In China,more than 90% of hospitalized patients with ACS carried at least one major risk factor.There is still room for improving in the application of drugs recommended by the guidelines,especially for ACS patients without PCI.

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