冠心病患者规范用药的依从性及其影响因素  

Compliance and influence factors of standardized medication in patients with coronary artery disease

作　　者：胡永仓 张建华[2] 汪家才 李荣成[1] 丁超[1] 陈炎炎[1] 李先楠 徐岩[3] 

机构地区：[1] 六安市立医院心内科 安徽省六安,237006 [2] 中山大学孙逸仙纪念医院心内科 [3] 安徽医科大学第一附属医院心内科

出　　处：《中国基层医药》2015年第10期1441-1443,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省科技攻关项目（09010302083）

摘　　要：目的：调查冠心病患者在院及出院后1年的规范化药物服用情况以及影响规范用药的原因。方法续贯纳入2010-2012年在六安市立医院经冠状动脉造影检查被首次确诊为冠心病的患者165例，其中稳定型心绞痛61例，不稳定型心绞痛67例，急性心肌梗死37例。分析每例患者在院时服药情况，并随访出院后1年时的药物服用情况。结果冠心病患者在院期间同时正规服用抗血小板药物、他汀类调脂药物、β受体阻滞剂及血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂这四类药物的比例为55％，而随访1年时仅有45％患者还在坚持正规服用这四类药物（χ2＝81．04，P ＜0．01）。患者不正规服药原因的分析结果发现，61％的患者随意停药，15％的患者遵医嘱停药，20％的患者停药原因是经济困难，药物本身不良反应所导致的停药比例仅占4％。结论冠心病患者在院及出院后1年的正规服药率较低。冠心病患者不正规服药的绝大部分原因是管理不够导致的患者随意停药，以及医生没有规范化药物二级预防意识导致的医嘱停药。因此，增强基层医生规范化治疗的意识及加强患者出院后的管理在以后的工作中是十分必要的。Objective To evaluate the standardized drug treatment and its influence factors of patients,with coronary artery disease,in hospital and one year after discharge.Methods The study enrolled sequentially 165 patients who were firstly diagnosed of coronary artery disease,61 cases with stable angina,67 cases with unstable angi-na and 37 cases of acute myocardial infarction,by coronary artery angiography from 2010 to 2012.The standardized drug treatment and its influence factors of patients were analyzed at hospital and 1 year after discharge in the present study.Results Fifty five percent patients with coronary artery disease at hospital regularly took the four drugs,anti-platelet agents,statins,beta blockers and angiotensin converting enzyme inhibitors/angiotensin II receptor antagonist. The ratio decreased to forty five percent one year after discharge（χ2 =81.04,P 〈0.01）.The reasons of the irregular medication taken were optional withdrawal（61%）,following the doctors′advice（15%）,economic hardship（20%） and the drugs′adverse reaction（4%）.Conclusion The results of the present study showed that the rate of regular medication in patients with coronary artery disease is low in hospital and 1 year after discharge.The major reasons of the irregular medicine taken were the patients′optional withdrawal and the consciousness of second prevention was lack in doctors in our hospital.Therefore,the increase of the consciousness of regular standardized treatment in prima-ry care physicians and strengthen the management of the patients after discharge form hospital.

关 键 词：冠状动脉疾病 抗血小板药 他汀类调脂药 Β受体阻滞剂 血管紧张素转化酶抑制剂/血管紧张素 2 受体拮抗剂 

分 类 号：R541.4[医药卫生—心血管疾病]