中国西医医院中急性心肌梗死的中医药治疗
Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China.
作者信息
Spatz Erica S, Wang Yongfei, Beckman Adam L, Wu Xuekun, Lu Yuan, Du Xue, Li Jing, Xu Xiao, Davidson Patricia M, Masoudi Frederick A, Spertus John A, Krumholz Harlan M, Jiang Lixin
机构信息
From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (E.S.S., Y.W., Y.L., X.X., H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., Y.W., H.M.K.), Department of Obstetrics and Gynecology and Reproductive Sciences (X.X.), Yale School of Medicine, New Haven, CT; Harvard Medical School, Boston, MA (A.L.B.); National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China (X.W., X.D., J.L., L.J.); Johns Hopkins School of Nursing, Baltimore, MD (P.M.D.); University of Colorado Anschutz Medical Campus and the Colorado Cardiovascular Outcomes Research Consortium, Denver (F.A.M.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City (J.A.S.); and Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT (H.M.K.).
出版信息
Circ Cardiovasc Qual Outcomes. 2018 Mar;11(3):e004190. doi: 10.1161/CIRCOUTCOMES.117.004190.
BACKGROUND
Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI).
METHODS AND RESULTS
We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%; <0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98-4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality.
CONCLUSIONS
Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world's most populous country.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.
背景
在中国全国致力于提高心血管疾病患者护理质量的背景下，中药的使用正在增加，但对于其在急性心肌梗死（AMI）早期管理中的应用知之甚少。
方法与结果
我们旨在研究AMI住院后24小时内中药的静脉使用情况（早期静脉用中药）。数据来自中国以患者为中心的心脏事件评估性急性心肌梗死回顾性研究，该研究局限于中国各地大型、具有代表性的西医医院样本（n = 162）。我们对2001年、2006年和2011年随机抽取的AMI患者进行了病历审查，比较了各年份早期静脉用中药的使用情况、任何早期静脉用中药使用的预测因素以及与院内出血和死亡率的关联。从2001年到2011年，早期静脉用中药的使用有所增加（2001年：38.2%，2006年：49.1%，2011年：56.1%；P<0.01）。几乎所有（99%）医院都使用早期静脉用中药。丹参是最常处方的药物，在所有AMI入院患者中有三分之一（35.5%）使用。接受任何早期静脉用中药的患者与未接受的患者在年龄和性别上相似，且心血管危险因素较少。在多变量分层模型中，二级（相对于三级）医院入院与早期静脉用中药使用的关联最为强烈（比值比：2.85；95%置信区间：1.98 - 4.11）。医院层面的因素占变异的55%（调整后的中位数比值比：2.84）。在探索性分析中，早期静脉用中药与院内出血或死亡率之间无显著关联。
结论
尽管缺乏其益处或危害的证据，但中国AMI早期静脉用中药的使用仍在增加。迫切需要明确这些药物的作用，因为它们已成为世界上人口最多国家治疗的主要手段。
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