急性心肌梗死治疗现状分析

目的: 了解急性心肌梗死(AMI)患者住院期间治疗现状及与指南差距。方法: 选自2002年12月~2005年11月AMI住院患者92例,统计分析接受药物阿司匹林、低分子肝素、硝酸脂类、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、他汀类调脂药及静脉溶栓、经皮冠状动脉介入治疗(PCI)临床应用情况。结果: 患者住院期间不同年度阿司匹林使用率90.32%~93.10%,低分子肝素70.97%~82.76%,硝酸脂类78.13%~80.65%,β-受体阻滞剂62.50%~65.52%,ACEI46.88%~58.62%,他汀类调脂药6.25%~68.97%;再灌注治疗中,静脉溶栓31.25%~41.38%,PCI3.13%~17.24%。结论: 经循证医学证实有效治疗措施大部分在二级甲等医院已得到较好的应用,部分措施已达三甲医院水平,PCI应用差距最大,且短期内难以改善,静脉溶栓仍是早期再灌注主要途径。

Comparison of current clinical practice in therapy of acute myocardial infarction

Objective: To understand the gap between the current practice of medications on patients with acute myocardial infarction(AMI) in hospital and guideline application.Methods: Ninety-two patients with AMI from Tongcheng People's Hospital received different therapies in Department of Cardiology from December 2002 to November 2005.The application of aspirin,low molecular heparin(LWMH),Nitrates,β-blocker,angiotensin converting enzyme inhibitors(ACEI),reperfusion,percutaneous corongary intervention(PCI) and cholesterol lowering agents were analyzed on different AMI patients.Results: Percentage of medications in AMI patients in different periods was:aspirin 90.32% to 93.10%,LWMH 70.97% to 82.76%,Nitrates 78.13% to 80.65%,β-blocker 62.50% to 65.52%,ACEI 46.88% to 58.62%,cholesterol lowering agents 6.25% to 68.79%,Fibrinolytics 31.25% to 41.38%,PCI3.13% to 17.24%.Conclusions: Application of medications proved effective by evidence-based medicine in clinical practice is mostly better in the class A gradeⅡ hospitals,and partly equal to the class A grade Ⅲ hospitals.But the application in China could be further improved.The gap of PCI application is quite big and it's hard to improve fast.Fibrinolytics is still the main method of reperfusion in the early period.