我国示范乡镇卫生院基本药物循证评价与遴选之十一：冠心病_《中国循证医学杂志》

作者：

沈建通 , 杨晓妍 ,  李幼平 , 王莉 , 周萍 , 辛哲梅 , 李鸿浩 , 王应强 , 李萃萃 , 李筱 , 李向莲 , 杨宗霞

四川大学华西医院中国循证医学中心（成都 610041）;

关键词：

乡镇卫生院基本药物循证评价与遴选冠心病

DOI：

10.7507/1672-2531.20120150

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　基于疾病负担，循证遴选中国乡镇卫生院治疗冠心病的基本药物。
方法　应用本系列研究之二制定的循证评价与遴选标准、方法和流程，循证评价并推荐治疗冠心病的基本药物。
结果　① 共纳入11个临床指南，含3个循证指南。② 各国指南共涉及冠心病治疗药物13类61种。③ 硝酸甘油、硝酸异山梨酯、美托洛尔、维拉帕米、硝苯地平、依那普利、阿司匹林和肝素均被WHO EML（2011）、NEML（2009）、CNF（2010）推荐，在各指南中证据相对较多，质量较高；普萘洛尔和辛伐他汀均被WHO EML（2011）、NEML（2009）、CNF（2010）推荐但在指南中证据相对较少；氨氯地平、氯吡格雷和链激酶虽未全被3个目录推荐但在指南中证据较多。④ 上述13个推荐药物国内均有相应剂型和规格上市，药物价格可负担。⑤ 中文低质量证据表明5个药物（硝酸甘油、硝酸异山梨酯、美托洛尔、阿司匹林和肝素）治疗冠心病有效，未检索到相关药物的中文系统评价和经济学评价证据。
结论　① 冠心病治疗药物强推荐硝酸甘油、硝酸异山梨酯、美托洛尔、维拉帕米、硝苯地平、依那普利、阿司匹林；弱推荐普萘洛尔、氨氯地平、氯吡格雷、肝素、链激酶、辛伐他汀。② 国内冠心病药物治疗研究证据质量不高，缺少经济学评价研究。③ 建议循证制定我国冠心病临床指南，规范全国临床治疗；开展冠心病药物经济学评价研究，进行同类比较成本-效果研究。

引用本文： 沈建通,杨晓妍,李幼平,王莉,周萍,辛哲梅,李鸿浩,王应强,李萃萃,李筱,李向莲,杨宗霞. 我国示范乡镇卫生院基本药物循证评价与遴选之十一：冠心病. 中国循证医学杂志, 2012, 12(8): 948-957. doi: 10.7507/1672-2531.20120150 复制

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1. 未来10年我国心血管疾病将大流行. 医学研究杂志, 2008, (2): 55.
2. 卫生部. 2010年中国卫生统计年鉴.
3. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部基本药物系列之二: 评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
4. National Clinical Guideline Centre. Management of stable angina. 2011. www.nice.org.uk.
5. National Clinical Guideline Centre. The early management of unstable angina and non-ST-segment-elevation myocardial infarction. 2010. www.nice.org.uk.
6. Cooper A, Skinner J, Nherera L, et al. Clinical Guidelines and Evidence Review for Post Myocardial Infarction: Secondary prevention in primary and secondary care for patients following a myocardial infarction London: National Collaborating Centre for Primary Care and Royal College of General Practitioners.
7. Wright RS, Anderson JL, Adams CD, et al. 2011ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force n Practice Guidelines. J Am Coll Cardiol, 2011, 57.
8. Kushner FG, Hand M, Smith SC Jr, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2009, 54: 2205-2241.
9. Christian WH, Jean PB, Stefan A, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 2011, 32: 2999-3054.
10. Frans VW, Jeroen B, Amadeo B, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. European Heart Journal, 2008, 29: 2909-2945.
11. Kim F, Maria A, Diego A, et al. Guidelines on the management of stable angina pectoris. European Heart Journal, 2006, 27: 1341-1381.
12. 中华医学会心血管病学分会, 中华心血管病杂志编委会. 急性ST段抬高型心肌梗死诊断和治疗指南. 中华心血管病杂志, 2010, 38(8): 675-690.
13. 中华医学会心血管病学分会, 中华心血管病杂志编委会. 不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南. 中华心血管病杂志, 2007, 35(4): 295-304.
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15. 关秀萍, 黎明丽, 杨柳. 硝酸甘油单用与联用治疗不稳定性心绞痛疗效的Meta分析. 中国组织工程研究与临床康复, 2011, 15(33): 6243-6246.
16. 地尔硫卓协作组. 静脉注射地尔硫卓治疗不稳定性心绞痛多中心随机对照试验. 中华心血管病杂志, 2005, 33(3): 238-242.
17. 黄祥可, 李耀华. 单硝酸异山梨酯治疗冠心病不稳定型心绞痛的疗效观察. 中华临床医学杂志, 2005, 6(1): 91-92.
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20. 张三强. 单硝酸异山梨酯治疗劳累性心绞痛50例. 新乡医学院学报, 2002, 19(4): 308-309.
21. 李士玉, 马玉玲, 冯国伟, 等. 静脉滴注单硝酸异山梨酯治疗心绞痛的疗效及安全性. 中国临床药理学杂志, 2002, 18(1): 7-11.
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23. 李小华, 孙毅毅. 肝素与低分子肝素治疗ST段抬高性心肌梗死有效性和安全性的Meta分析.中国药房, 2011, 22(24): 2272-2275.
24. 低分子量肝素临床研究协作组. 不稳定性心绞痛、急性非q波心肌梗死不同抗栓疗法的对比研究. 中华心血管病杂志, 2000, 28(1): 18-21.
25. 卢海崧, 刘新颜. 低分子肝素与阿斯匹林治疗不稳定心绞痛疗效对比观察. 井冈山学院学报(自然科学版), 2006, 27(2): 82-83.
26. 徐健, 丁晓梅, 范西真, 等. 低分子肝素治疗142例不稳定型心绞痛临床评价. 安徽医学, 2000, 21(4): 12-13.
27. 张国强. 低分子肝素与普通肝素治疗急性心肌梗死105例临床疗效分析. 山东医药, 2009, 49(29): 45-46.
28. 全玉锦. 阿司匹林预防心肌梗死有效性的Meta分析. 中国临床康复, .2006, 10(20): 156.
29. 于海晴. 阿司匹林对心脑血管疾病的预防研究. 中国医药指南, 2011, 9(34): 316-317.
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我国示范乡镇卫生院基本药物循证评价与遴选之十一：冠心病

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《中国循证医学杂志》

我国示范乡镇卫生院基本药物循证评价与遴选之十一：冠心病

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