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基于证据的药物治疗在冠心病二级预防中的应用:中医院与综合医院的比较。

Use of evidence-based pharmacotherapy for secondary prevention of coronary heart disease: a Chinese medicine hospital versus a general hospital.

机构信息

Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.

出版信息

Chin J Integr Med. 2014 May;20(5):375-80. doi: 10.1007/s11655-013-1663-8. Epub 2014 Jan 23.

Abstract

OBJECTIVE

To determine differences in adherence to secondary prevention guidelines (pharmacological interventions) among coronary heart disease (CHD) patients between a Chinese medicine (CM) hospital and a general hospital in a Chinese city.

METHODS

Medical records of 200 patients consecutively discharged from the CM hospital and the general hospital for CHD were reviewed to determine the proportions of eligible patients who received antiplatelet agents, β-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and statins at discharge. The effects of patient characteristics and hospital type on the use of these medicines were estimated using logistic regression models.

RESULTS

Patients discharged from the CM hospitals were older; more likely females; had greater history of hyperlipidemia, cerebrovascular diseases and less smoker (P<0.01 or P<0.05). They were less likely to receive coronary angiography and percutaneous coronary intervention, and had a longer length of stay than those discharged from the general hospital (P<0.01 or P<0.05). There were no significant differences in antiplatelet agents (96% vs. 100%, P=0.121) or statins (97.9% vs. 100%, P=0.149) use between the CM hospital and the general hospital. In multivariable analyses that adjusted for patient characteristics and hospital type, there was no significant difference in use of β-blockers between the CM hospital and the general hospital. In contrast, patients discharged from the CM hospital were less likely to receive ACE inhibitors/ARBs compared with those discharged from the general hospital (odds ratio: 0.3, 95% confidence interval: 0.105-0.854).

CONCLUSION

In this study, the CM hospital provides the same quality of care in CHD for prescribing evidence-based medications at discharge compared with another general hospital except for ACE inhibitors/ARBs use.

摘要

目的

确定中国某城市一家中医院和一家综合医院的冠心病(CHD)患者在遵循二级预防指南(药物干预)方面的差异。

方法

回顾性分析 200 例连续出院的 CHD 患者的病历,以确定在出院时接受抗血小板药物、β受体阻滞剂、血管紧张素转换酶(ACE)抑制剂或血管紧张素受体阻滞剂(ARB)和他汀类药物的合格患者比例。使用逻辑回归模型估计患者特征和医院类型对这些药物使用的影响。

结果

从中医院出院的患者年龄较大;更可能为女性;有更多的高脂血症、脑血管疾病史,且吸烟者较少(P<0.01 或 P<0.05)。他们接受冠状动脉造影和经皮冠状动脉介入治疗的可能性较小,住院时间也比从综合医院出院的患者长(P<0.01 或 P<0.05)。从中医院和综合医院出院的患者在使用抗血小板药物(96%对 100%,P=0.121)或他汀类药物(97.9%对 100%,P=0.149)方面无显著差异。在调整患者特征和医院类型的多变量分析中,从中医院出院的患者与从综合医院出院的患者相比,使用β受体阻滞剂无显著差异。相比之下,从中医院出院的患者接受 ACE 抑制剂/ARB 的可能性低于从综合医院出院的患者(比值比:0.3,95%置信区间:0.105-0.854)。

结论

在这项研究中,与另一家综合医院相比,中医院在开具基于证据的药物方面为 CHD 患者提供了相同质量的护理,除了 ACE 抑制剂/ARB 的使用。

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