• 四川大學(xué)華西醫(yī)院,老年病科,成都,610041;

目的 　了解本科室老年心血管病患者藥物治療的合理性和循證實踐效果.
方法 　調(diào)查四川大學(xué)華西醫(yī)院老年科1998～1999年及2002～2003年心血管疾病患者(各211例)用藥情況,比較循證實踐前后臨床用藥的變化.
結(jié)果 　循證實踐后,降壓藥物使用中血管緊張素轉(zhuǎn)換酶抑制劑、利尿劑的地位提高,短效鈣拮抗劑、血管緊張素轉(zhuǎn)換酶抑制劑仍然是最常用的種類;聯(lián)合用藥更普遍.治療冠心病藥物中,降脂藥物及血管緊張素轉(zhuǎn)換酶抑制劑應(yīng)用更常見;更注重生活質(zhì)量,聯(lián)用抗焦慮治療.心衰治療中,β-受體阻滯劑、安體舒通及血管緊張素轉(zhuǎn)換酶抑制劑的應(yīng)用更受重視.
結(jié)論 　循證實踐前用藥主要根據(jù)臨床經(jīng)驗及教科書,循證實踐后臨床用藥更注重證據(jù)支持,血壓控制達標率更理想.合理用藥比例由循證實踐之前的42%上升為循證實踐后的78%.

引用本文： 舒德芬,董碧蓉. 老年病房循證實踐前后心血管疾病合理用藥比較. 中國循證醫(yī)學(xué)雜志, 2004, 04(5): 314-317. doi: 復(fù)制

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2. ［2］Carroll CA, Coen MM, Rymer MM. Assessment of the effect of ramipril therapy on direct health care costs for first and recurrent strokes in high-risk cardiovascular patients using data from the Heart Outcomes Prevention Evaluation ( HOPE )study[J]. Clin Ther, 2003; 25(4):1 248- 1 261.
3. ［3］Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) [ J ]. Hypertension, 2003; 42(3) :239 -246.
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5. ［5］Marz W, Wieland H. HMG-CoA reductase inhibition: antiinflammatory effects beyond hpid lowering[J] .9 Herz, 2000;25(2) :117 -125.
6. ［6］The Care Investigators. Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study [J]. Circulation, 1999; 99(2) :216 -223.
7. ［7］Coumadin Aspirin Re-infarction Study(CHRS) Investigators.Randomized double-blind trial of fixed low dose warfarin with aspirin after myocardial infarction [ J ]. Lancet, 1997; 350 ( 9049) :375 -380.
8. ［8］Antithrombotic Trialists’ Collaboration. Collaborative mete-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients [J]. BMJ, 2002; 324(7 329) :71 -86.
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10. ［10］Swenson JR, O’ Connor CM, Barton D, Van Zyl LT,Swedberg K, Forman LM, Gaffney M, Glassman AH; Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group. Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome [J]. Am J Cardiol, 2003; 92(11) :1 271 -1 276.
11. ［11］Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G,Pitula CR, Froelicher ES, Czajkowski S, Younghlood M,Huber M, Berkman LF. A Short Social Support Measure for Patients Recovering From Myocardial Infarction: the ENRICHD Social Support Inventory[J]. J Cardiopulm Rehabil,2003 ;23(6) :398 -403.
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13. ［13］Berkow R, Editor-in-Chief. Fletcher AJ, Chir B, Assistant Editor. The Merck Manual of Diagnosis and Therapy [ C ].In: Cardiovascular Disorders, Section 3, Chapter 25 Heart Failure . 16 Ed. Rahway: Published by Merck Research Laboratories Division of Merck & Co, 1992:445 - 446.
  1. 1. ［1］Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA,Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I; Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes [J ]. N Engl J Med, 2001; 345 ( 12 ): 851 -860.
  2. 2. ［2］Carroll CA, Coen MM, Rymer MM. Assessment of the effect of ramipril therapy on direct health care costs for first and recurrent strokes in high-risk cardiovascular patients using data from the Heart Outcomes Prevention Evaluation ( HOPE )study[J]. Clin Ther, 2003; 25(4):1 248- 1 261.
  3. 3. ［3］Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) [ J ]. Hypertension, 2003; 42(3) :239 -246.
  4. 4. ［4］Blood pressure in Acute Stroke Cllaboration(BASC). Interventions for deliberately altering blood pressure in acute stroke.(systematic review) [ CD/M]. The Cochrane Library 2003,Issue 4.
  5. 5. ［5］Marz W, Wieland H. HMG-CoA reductase inhibition: antiinflammatory effects beyond hpid lowering[J] .9 Herz, 2000;25(2) :117 -125.
  6. 6. ［6］The Care Investigators. Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study [J]. Circulation, 1999; 99(2) :216 -223.
  7. 7. ［7］Coumadin Aspirin Re-infarction Study(CHRS) Investigators.Randomized double-blind trial of fixed low dose warfarin with aspirin after myocardial infarction [ J ]. Lancet, 1997; 350 ( 9049) :375 -380.
  8. 8. ［8］Antithrombotic Trialists’ Collaboration. Collaborative mete-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients [J]. BMJ, 2002; 324(7 329) :71 -86.
  9. 9. ［9］Magee KD, Sevcik W, Moher D, Rowe BH. low molecular weight heparins versus unfractionated heparin for acute coronary syndromes( systematic review) [ CD/M ]. the Cochrane Library 2003, Issue 4.
  10. 10. ［10］Swenson JR, O’ Connor CM, Barton D, Van Zyl LT,Swedberg K, Forman LM, Gaffney M, Glassman AH; Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group. Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome [J]. Am J Cardiol, 2003; 92(11) :1 271 -1 276.
  11. 11. ［11］Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G,Pitula CR, Froelicher ES, Czajkowski S, Younghlood M,Huber M, Berkman LF. A Short Social Support Measure for Patients Recovering From Myocardial Infarction: the ENRICHD Social Support Inventory[J]. J Cardiopulm Rehabil,2003 ;23(6) :398 -403.
  12. 12. ［12］Hood WB Jr, Dans AL, Guyatt GH, Jaeschke R, McMurray JJV. Digitalis for treatment of congestive heart failure in patients in sinus rhythm (systematic review) [ CD/M]. the Cochrane Library 2003, Issue 4.
  13. 13. ［13］Berkow R, Editor-in-Chief. Fletcher AJ, Chir B, Assistant Editor. The Merck Manual of Diagnosis and Therapy [ C ].In: Cardiovascular Disorders, Section 3, Chapter 25 Heart Failure . 16 Ed. Rahway: Published by Merck Research Laboratories Division of Merck & Co, 1992:445 - 446.