我國示范鄉鎮衛生院基本藥物循證評價與遴選之十一：冠心病_《中國循證醫學雜志》

作者：

沈建通 , 楊曉妍 ,  李幼平 , 王莉 , 周萍 , 辛哲梅 , 李鴻浩 , 王應強 , 李萃萃 , 李筱 , 李向蓮 , 楊宗霞

四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

鄉鎮衛生院基本藥物循證評價與遴選冠心病

DOI：

10.7507/1672-2531.20120150

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　基于疾病負擔，循證遴選中國鄉鎮衛生院治療冠心病的基本藥物。
方法　應用本系列研究之二制定的循證評價與遴選標準、方法和流程，循證評價并推薦治療冠心病的基本藥物。
結果　① 共納入11個臨床指南，含3個循證指南。② 各國指南共涉及冠心病治療藥物13類61種。③ 硝酸甘油、硝酸異山梨酯、美托洛爾、維拉帕米、硝苯地平、依那普利、阿司匹林和肝素均被WHO EML（2011）、NEML（2009）、CNF（2010）推薦，在各指南中證據相對較多，質量較高；普萘洛爾和辛伐他汀均被WHO EML（2011）、NEML（2009）、CNF（2010）推薦但在指南中證據相對較少；氨氯地平、氯吡格雷和鏈激酶雖未全被3個目錄推薦但在指南中證據較多。④ 上述13個推薦藥物國內均有相應劑型和規格上市，藥物價格可負擔。⑤ 中文低質量證據表明5個藥物（硝酸甘油、硝酸異山梨酯、美托洛爾、阿司匹林和肝素）治療冠心病有效，未檢索到相關藥物的中文系統評價和經濟學評價證據。
結論　① 冠心病治療藥物強推薦硝酸甘油、硝酸異山梨酯、美托洛爾、維拉帕米、硝苯地平、依那普利、阿司匹林；弱推薦普萘洛爾、氨氯地平、氯吡格雷、肝素、鏈激酶、辛伐他汀。② 國內冠心病藥物治療研究證據質量不高，缺少經濟學評價研究。③ 建議循證制定我國冠心病臨床指南，規范全國臨床治療；開展冠心病藥物經濟學評價研究，進行同類比較成本-效果研究。

引用本文： 沈建通,楊曉妍,李幼平,王莉,周萍,辛哲梅,李鴻浩,王應強,李萃萃,李筱,李向蓮,楊宗霞. 我國示范鄉鎮衛生院基本藥物循證評價與遴選之十一：冠心病. 中國循證醫學雜志, 2012, 12(8): 948-957. doi: 10.7507/1672-2531.20120150 復制

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2. 衛生部. 2010年中國衛生統計年鑒.
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23. 李小華, 孫毅毅. 肝素與低分子肝素治療ST段抬高性心肌梗死有效性和安全性的Meta分析.中國藥房, 2011, 22(24): 2272-2275.
24. 低分子量肝素臨床研究協作組. 不穩定性心絞痛、急性非q波心肌梗死不同抗栓療法的對比研究. 中華心血管病雜志, 2000, 28(1): 18-21.
25. 盧海崧, 劉新顏. 低分子肝素與阿斯匹林治療不穩定心絞痛療效對比觀察. 井岡山學院學報(自然科學版), 2006, 27(2): 82-83.
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我國示范鄉鎮衛生院基本藥物循證評價與遴選之十一：冠心病

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《中國循證醫學雜志》

我國示范鄉鎮衛生院基本藥物循證評價與遴選之十一：冠心病

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