我国急性心肌梗死诊断和治疗指南对住院患者治疗和预后的影响

目的探讨我国2001年12月中华医学会心血管病学分会等制订的急性心肌梗死（AMI）诊断和治疗指南（简称2001年指南）对AMI患者住院治疗和预后的影响。方法回顾性研究1994年1月—2004年12月11年间在我院住院的所有AMI病例,对比2001年指南发布前后AMI住院治疗方法和并发症的差异。结果共有1783例患者入选,指南发布前（1994年1月-2001年12月）1208例,发布后（2002年1月-2004年12月）575例。指南发布前后AMI患者的临床特征比较无统计学意义（P均〉0．05）。指南发布后急性期再灌注治疗率和住院期问B受体阻滞剂、血管紧张素转化酶抑制剂（ACEI）或血管紧张素Ⅱ受体阻断剂（ARB）类药物、调脂药和肝素等的使用率均较指南发布前显著提高（P均〈0．001）,硝酸酯类和抗血小板药物的使用率与指南发布前比较也有所变化,但差异未达统计学意义（P均〉0．05）。指南发布后住院期间心绞痛、心力衰竭和病死的发生率较发布前明显降低（分别为32．2％比41．2％,P〈0．001;17．2％比26．2％,P〈0．001;6．4％比9．4％,P=0．038）,再次心肌梗死率也有所降低,但未达统计学意义（1．7％比2．2％,P=0．492）。结论我国急性心肌梗死诊断和治疗指南对住院治疗影响显著,治疗使之更趋规范化,并显著降低了住院期间并发症的发生率。

Effect of Chinese guidelines issued in 2001 on in-hospital management and prognosis of patients with acute myocardial infarction

Objective To evaluate the effect of Chinese guidelines issued on December 2001 on in-hospital management and prognosis of patients with acute myocardial infarction.Methods A retrospective study was carried out in patients hospitalized in our hospital with acute myocardial infarction from January 1994 to December 2004.Results There were 1783 patients enrolled in our study. Reperfusion therapy was undergone in 21.7% of patients hospitalized between 1994 and 2001,and in 35.8% of patients hospitalized between 2002 and 2004( P<0.001).Beta-blockers, ACE inhibitors and/or angiotensin receptor blockers , lipid regulating agents and antithrombins were used more extensively between 2002 and 2004 than before( all P<0.001). There were no significant differences in the usage of nitrates and antiplatelets before and after the guidelines was issued(98.8% vs 97.9%,P=0.172;97.4% vs 98.6%,P=0.113 respectively). After the guidelines issued ,the incidence of angina pectoris , heart failure and death in hospital were lower than before(32.2% vs 41.2%,P<0.001;17.2% vs 26.2%,P<0.001;6.4% vs 9.4%, P=0.038).Conclusions Chinese guidelines issued on December 2001 have great effect on the management and prognosis of patients with acute myocardial infarction. After the guidelines was issued the management became more standardized and the incidence of in-hospital complications was lower than before.