缺血性卒中二级预防药物治疗依从性及应用现状的随访研究  

Secondary Preventive Medication Adherence in Patients with Ischemic Stroke after Discharge

作　　者：周子懿[1,2] 魏琳[1,2] 张小培[1,2] 陈燕华[1,2] 乔立军[1,2] 杨伟林[1,2] 王立新[1,2] 蔡业峰[1,2] 

机构地区：[1]广东省中医院 [2]广州中医药大学第二附属医院脑血管病中心,广东省广州市510120

出　　处：《中国全科医学》2014年第5期498-503,共6页Chinese General Practice

基　　金：广东省科学技术厅--广东省中医药科学院联合科研专项(2012A032500016);广东省医学科学技术研究基金(B2012158)

摘　　要：背景近年来国内外研究表明,缺血性卒中二级预防药物的应用和患者服药依从性均较差。目的评估缺血性卒中患者出院后12个月内抗血栓药物及控制危险因素药物的应用现状,分析缺血性卒中患者二级预防药物服药依从性差或停药的原因。方法前瞻性连续纳入2011年8月—2012年6月广东省中医院脑血管病中心住院的急性脑梗死或短暂性脑缺血发作患者,通过门诊及电话随访,对入选患者出院后12个月内的服药情况及停药原因等进行登记。遵医嘱服药天数≥总随访天数的80%为服药依从;随访时用药情况与出院时一致为服药持续。结果共纳入393例患者,31例被排除,362例进入随访研究,其中40例在随访期内因各种原因失访脱落,18例患者在随访期内死亡被剔除,最终304例(77.4%)完成12个月的随访研究。304例患者出院后12个月时抗血栓药物服药依从者217例。影响抗血栓药物服药依从性的相关因素有文化程度(χ2=5.523,P=0.019)、报销方式(χ2=12.233,P=0.002)及卒中亚型(χ2=16.562,P=0.000)。304例患者出院后阿司匹林各随访时间点服药依从性比较,差异有统计学意义(P<0.05),出院后6、12个月时服药依从性均低于出院后1个月时(P<0.05);氯吡格雷、双联及华法林各随访时间点服药依从性间差异无统计学意义(P>0.05)。服药持续性比较:出院12个月时,患者对4种抗血栓药物的服药持续性间差异有统计学意义(χ2=20.025,P=0.000),其中阿司匹林的服药持续性较氯吡格雷和双联服药持续性高(χ2=18.484,P=0.000;χ2=6.660,P=0.010)。患者出院12个月时降压药、降糖药、降脂药服药依从率分别为66.5%(157/236)、77.1%(84/109)和39.3%(92/234)。抗血栓药物服药依从性差的主要原因为不了解服药疗程〔54.0%(47/187)〕,降压药和降糖药服药依从性差的主要原因为检查指标正常自行停药〔26.6%(21/79),48.0(12/25)〕,降脂药服药依从性差的主要原�Background The recent studies have shown that the application of secondary prevention medication and patients＇ drug therapy compliance are poor. Objective To .evaluate the antithrombotie agent compliance of IS patients＇ and the application of drugs controlling risk factors and analyze the reasons for patients＇ poor medication compliance and discontinuation of medication. Methods The patients with acute myocardial infarction （AMI） or transient ischemic attack （TIA） hospitalized in this hospital from August 2011 to June 2012 were enrolled in this study. The status of medication and reasons for discontinuation of medication were recorded within 12 months after discharge 80% of follow- up days were considered as good compliance Medication days according doctors＇ advice equal to or more than Medication during follow - up consistent to that at discharge con-sidered as good persistence. Results A total of 393 patients were enrolled, 31 were excluded; 362 entered into follow - up study, including 40 losing follow -up due to varying reasons within 12 months, 18 excluded due to dying during follow -up, 304 （77.4%） completed the follow- up study at last. In the 304 patients, 217 had good compliance to antithrombotic agents, 87 had poor. The relevant factors influencing medication compliance were educational level （~2 = 5. 523, P = 0. 019）, reim- bursement methods （ ~5 = 12. 233, P = 0. 002） and stroke subtype （ ~2 = 16. 562, P = 0. 000）. There was significant differ- ence in medication compliance of aspirin at different time points after discharge （ P 〈 0. 05 ）. The compliance was lower in months 6, 12 than in month 1 after discharge （P 〈0. 05）. There was no difference in clopidogrel, doublet and warfarin compli- ance at different follow - up time points （P 〉 0. 05）. There was difference in medication persistence of 4 antithrombotic drugs in months 12 after discharge （~2 =20. 025, P =0. 000） , the persistence of aspirin was higher than that of clopidogrel and doublet （

关 键 词：卒中 预防和防护用药 自我遵嘱服药 

分 类 号：R743.31[医药卫生—神经病学与精神病学]