急诊主动脉夹层患者抗高血压用药分析
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摘要
目的了解急诊主动脉夹层患者抗高血压用药现状,为临床合理用药提供参考。方法利用医院管理信息系统(hospital information system,HIS)抽取广东省人民医院2016年1月至12月诊断为主动脉夹层的急诊电子处方,统计患者的年龄、性别、诊断、治疗用药等,根据国内、外文献及指南对用药合理性进行分析。结果共纳入急诊患者2 403例次,男性为主,占85.85%;45～60岁年龄段患者最多,占46.73%。1 703例次(70.87%)使用了抗高血压药物,其中使用β受体阻断药(βreceptor blocker,βRB)和钙通道阻滞剂(calciumchannel blockers,CCB)的患者最多,分别占60.07%和59.54%;降压方案以单用和二联为主,分别占45.10%和38.11%,其中使用CCB+βRB、CCB和βRB降压的患者最多,分别占18.85%、17.56%和13.92%,使用频次最高的降压药为地尔硫艹卓注射液、艾司洛尔注射液和硝普钠针注射液。是否并发高血压对降压方案选择无明显影响。结论该院急诊主动脉夹层患者以中青年男性为主,多选择βRB和CCB,以单用和二联为主,用药基本合理。
Objectives To understand the application status of antihypertensive drugs in emergency patients with aortic dissection(AD),and to provide the reference for the clinic.MethodsEmergency prescriptions with diagnosis of aortic dissection were randomly collected from hospital information system(HIS)during the whole 2016 year in Guangdong Provincial People′s Hospital,and the data of patient′s gender,age,diagnosis and medications,and the rationality of medications were evaluated by the domestic and overseas′guidelines.ReslutsOf the 2 403 patients included,male patients constituted 85.85%,and patients aged from 45 to 60 had the most composition ratio of46.73%;1 703 patients(70.87%)used antihypertensive drugs,in which most patients were prescribedβreceptor blocker(βRB,60.07%)and calcium channel blocker(CCB,59.54%);only one antihypertensive drug used or combined two drugs constituted 45.10%and 38.11%,respectively,in which the scheme of CCB plusβRB,CCB andβRB were most prescribed(18.85%,17.56%,13.92% respectively),while the single antihypertensive drug of diltiazem for injection,esmolol for injection and sodium nitroprusside for injection were most prescribed.Meanwhile,the scheme of antihypertension was not significant difference between AD patients with hypertension whether or not.ConclusionsAD patients in this clinic are mainly consisted of younger and middle aged males,βRB and CCB are most prescribed while one or two antihypertensive drugs are most common.In short,medications for AD are basically reasonable.
Objectives To understand the application status of antihypertensive drugs in emergency patients with aortic dissection(AD),and to provide the reference for the clinic.MethodsEmergency prescriptions with diagnosis of aortic dissection were randomly collected from hospital information system(HIS)during the whole 2016 year in Guangdong Provincial People′s Hospital,and the data of patient′s gender,age,diagnosis and medications,and the rationality of medications were evaluated by the domestic and overseas′guidelines.ReslutsOf the 2 403 patients included,male patients constituted 85.85%,and patients aged from 45 to 60 had the most composition ratio of46.73%;1 703 patients(70.87%)used antihypertensive drugs,in which most patients were prescribedβreceptor blocker(βRB,60.07%)and calcium channel blocker(CCB,59.54%);only one antihypertensive drug used or combined two drugs constituted 45.10%and 38.11%,respectively,in which the scheme of CCB plusβRB,CCB andβRB were most prescribed(18.85%,17.56%,13.92% respectively),while the single antihypertensive drug of diltiazem for injection,esmolol for injection and sodium nitroprusside for injection were most prescribed.Meanwhile,the scheme of antihypertension was not significant difference between AD patients with hypertension whether or not.ConclusionsAD patients in this clinic are mainly consisted of younger and middle aged males,βRB and CCB are most prescribed while one or two antihypertensive drugs are most common.In short,medications for AD are basically reasonable.
引文
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[12]宋先荣,韩雪萍,程兆云,等.河南省主动脉夹层病例临床特征变化趋势10年回顾性分析[J].中华胸心血管外科杂志,2014,30(3):164-166.
[13]薛凌,罗建方,黄文晖,等.主动脉夹层患者临床特征的性别差异[J].中华心血管病杂志,2008,36(5):415-417.
[14]中国医师协会急诊医师分会.中国急诊高血压诊疗专家共识[J].中国急救医学,2010,30(10):856.
[15]NIENABER C A,POWELL J T.Management of acute aortic syndromes[J].Eur Hcart J,2012,33(1):26-35.
[16]BECSHAN A,WOO E Y,BAVARIA J E,et a1.Thoracic endovascular aortic repair for acute cornplicated type B aortic dissection:superiority relative to conventional open surgical and medical therapy[J].J Thorac Cardiovasc Surg,2010,140(6 Suppl):S109-S115.
[17]NEFF E,SASSI C,MASSETTI M,et a1.Nonocclusive intestinal ischemia in patients with acute aortic dissection[J].JVasc Surg,2002,36(4):738-745.
[2]HIRATZKA L F,BAKRIS G L,BECKMAN J A,et al.2010ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVMGuidelines for the diagnosis and management of patients with thoracic aortic disease[J].J Am Coll Cardiol,2010,55(14):e27-e129.
[3]MESZAROS I,MOROCZ J,SZLAVI J,et al.Epidemiology and clinicopathology of aortic dissection[J].Chest,2000,117(5):1271-1278.
[4]ZHAO L,CHAI Y F,LI Z G.Clinical features and prognosis of patients with acute aortic dissection in China[J].J Int Med Res,2017,45(2):823-829.
[5]ZHANG J,QU J X,BAI C X,et al.Tobacco smoking in China:prevalence,disease burden,challenges and future strategies[J].Respirology,2011,16(8):1165-1172.
[6]LEWINGTON S,LACEY B,CLARKE R,et al.The burden of hypertension and associated risk for cardiovascular mortality in China[J].JAMA Intern Med,2016,176(4):524-532.
[7]MUSSA F F,HORTON J D,MORIDZADEH R,et al.Acute aortic dissection and intramural hematoma:a systematic review[J].JAMA,2016,316(7):754-763.
[8]HOWARD D P,BANERJEE A,FAIRHEAD J F,et al.Populationbased study of incidence and outcome of acute aortic dissection and premorbid risk factor control:10-year results from the Oxford Vascular Study[J].Circulation,2013,127(20):2031-2037.
[9]ERBEL R,ABOYANS V,BOILEAU C,et al.2014 ESCGuidelines on the diagnosis and treatment of aortic diseases:Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult[J].Eur Heart J,2014,35(41):2873-2926.
[10]赵路静,柴艳芬,李志刚.主动脉夹层患者临床特征与预后关系的研究[J].中华胸心血管外科杂志,2017,33(6):367-368.
[11]张源明,陈曦,木胡牙提,等.乌鲁木齐市主动脉夹层病例临床特征变化趋势10年回顾性分析[J].中华流行病学杂志,2008,29(7):720-723.
[12]宋先荣,韩雪萍,程兆云,等.河南省主动脉夹层病例临床特征变化趋势10年回顾性分析[J].中华胸心血管外科杂志,2014,30(3):164-166.
[13]薛凌,罗建方,黄文晖,等.主动脉夹层患者临床特征的性别差异[J].中华心血管病杂志,2008,36(5):415-417.
[14]中国医师协会急诊医师分会.中国急诊高血压诊疗专家共识[J].中国急救医学,2010,30(10):856.
[15]NIENABER C A,POWELL J T.Management of acute aortic syndromes[J].Eur Hcart J,2012,33(1):26-35.
[16]BECSHAN A,WOO E Y,BAVARIA J E,et a1.Thoracic endovascular aortic repair for acute cornplicated type B aortic dissection:superiority relative to conventional open surgical and medical therapy[J].J Thorac Cardiovasc Surg,2010,140(6 Suppl):S109-S115.
[17]NEFF E,SASSI C,MASSETTI M,et a1.Nonocclusive intestinal ischemia in patients with acute aortic dissection[J].JVasc Surg,2002,36(4):738-745.