北京市11家医院缺血性卒中和短暂性脑缺血发作患者血压控制状况的横断面调查  

Blood Pressure Control in Patients with Ischemic Stroke and TIA in Beijing:a Cross-sectional Study

作　　者：吴敌[1] 王伊龙[1] 周永[1] 王春雪[1] 赵性泉[1] 王拥军[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科

出　　处：《中国卒中杂志》2009年第6期464-469,共6页Chinese Journal of Stroke

基　　金：北京市科学技术委员会重大项目(D0905004040231);“十一五”国家科技支撑计划项目(2006BAI01A11)

摘　　要：目的评估北京地区缺血性卒中和短暂性脑缺血发作（transien tischemic attack,TIA）患者血压控制及降血压药物使用现况。方法采用横断面调查方法,对北京11个医院神经内科门诊就诊缺血性卒中或TIA诊断明确的连续病例近期的血压控制及降血压药物使用情况进行调查。结果2006年7月1日～8月15日期间11个医院参加调查,总计1247例缺血性卒中和TIA患者患者连续入选纳入分析,其中伴高血压者919例（73.7%）,血压控制达标率[按收缩压（SBP）〈140mmHg和舒张压（DBP）〈90mmHg]为46.8%（413/919）。伴糖尿病者297例,血压控制达标率[按SBP〈130mmHg和DBP〈80mmHg]为13.1%（39/297）。伴高血压者919例中,739例患者使用各种降血压药物,使用比例分别为钙通道阻滞剂（calcium channel blocker,CCB）61.2%（452/739）、肾素-血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitor,ACEI）26.8%（198/739）、β-受体阻滞剂15.7%（116/739）、复方制剂15.2%（112/739）、利尿剂8.0%（59/739）、血管紧张素II受体拮抗剂（angiotensin II receptor antagonist,ARB）7.7%（57/739）、α-受体阻滞剂1.3%（13/739）。关于患者未用药的原因：42.7%（53/124）患者认为血压已控制故停药,其次29.8%（37/124）的患者回答是医生未建议。结论北京市缺血性卒中和TIA患者血压控制水平参照临床指南要求目标值达标率偏低,伴糖尿病的患者血压控制更不理想,亟待加强对卒中患者血压的控制,缩短临床实践与指南间的差距。Objective To assess the current status of blood pressure control and antihypertensive drugs use in patients with ischemic stroke and transient ischemic attack （TIA）, and to identify the potential factors associated with the use of these drugs in Beijing. Methods We conducted a cross-sectional survey to investigate the administration of antihypertensive drugs in patients with IS or TIA at 11 neurological clinics in Beijing from July 01 to August 15, 2006. All subjects diagnosed with chemic stroke or transient ischemic attack （TIA） were enrolled consecutively. Results Overall, 1247 patients were included. Hypertension was diagnosed in 919 （73.7%） of total patients, of whom 413 （46.8%） had systolic blood pressure （SBP） 〈140mmHg and diastolic blood pressure （DBP） 〈90mmHg. In addition, only 39 （13.1%） of 297 patients with diabetes had BP under control （SBP〈130mmHg and DBP〈80mmHg）. Of 919 patients with hypertension, 739 patients had at least an antihypertensive therapy prescription. The percentages of different types were as follows： calcium channel blocker （CCB）, 61.2%（452/739）; angiotensin converting enzyme inhibitor （ACEI）, 26.8% （198/739）;β-receptor blocker, 15.7% （116/739）; compound preparation, 15.2% （112/739）; diuretics, 8.0% （59/739）; angiotensin-II receptor blocker （ARB）, 7.7% （57/739）;et-receptor blocker, 1.3% （13/739）. The main reasons for non-use of antihypertensive drug were patients thought their condition turning better （42.7%） and lacked of doctors＇ recommendation （29.8%）. Conclusion The adherences to guideline of secondary prevention among ischemic stroke or TIA patients in the hospitals in Beijing are very poor. BP control among ischemic stroke or TIA patients in the hospitals of major metropolitan cities in China does not reach the BP goals recommended by clinical guidelines, especially in the patients with diabetes. Effective strategies must be implemented to close the gap between clinical guidelines and pra

关 键 词：卒中 高血压 二级预防 市区卫生服务 

分 类 号：R743.3[医药卫生—神经病学与精神病学]