缺血性脑血管病合并非瓣膜性房颤患者二级预防药物效果评价及依从性研究  

STUDY ON EFFECTIVENESS ALUATION AND COMPLIANCE OF SECONDARY PREVENTIVE DRUGS IN PATIENTS WHO HAVE ISCHEMIC CEREBROVASCULAR DISEASE WITH NO-VALVULAR ATRIAL FIBRILLATION

作　　者：吴雅坤 阚凤杰 曹亦宾 钱庆强 黄文姬 范秋爽 程希玥 WU Yakun;KAN Fengjie;CAO Yibin;QIAN Qingqiang;HUANG Wenji;FAN Qiushuang;CHENG Xiyue(Tangshan Workers’Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市工人医院神经内科,063000

出　　处：《中国煤炭工业医学杂志》2022年第3期264-270,共7页Chinese Journal of Coal Industry Medicine

基　　金：河北省卫生厅重点课题(编号:20171287)。

摘　　要：目的 评价缺血性脑血管病合并非瓣膜性房颤患者二级预防药物效果,并对影响其依从性因素进行分析,以期为缺血性脑血管病合并非瓣膜性房颤患者二级预防用药提供参考。方法 对2018年1月—2020年12月在唐山市工人医院住院的缺血性脑血管病合并非瓣膜性房颤的198例患者进行回顾性分析,对所有患者进行为期12个月的门诊或电话随访,对其用药情况进行登记,并详细记录患者的用药现状、停药原因、临床事件,评价其二级预防用药的效果,并对影响患者二级预防药物依从性的因素进行分析。结果 出院后应用抗血小板药物的119例患者3个月与6个月及3个月与12个月药物依从性差异有统计学意义(P<0.05),而出院6个月与出院12个月药物依从性差异无统计学意义(P>0.05);抗凝药、降压药、降糖药在各随访时间点服药依从性差异无统计学意义(P>0.05);降脂药在各随访时间点服药依从性差异有统计学意义(P<0.05)。198例患者出院12个月后抗栓药物依从性方面,高依从性140例(70.70%),低依从性58例(29.30%)。通过本研究发现高龄、文化程度低、没有医保、收入水平较低、没有按时随访复查、没有得到规范合理的患者教育、依靠患者家属给药均会导致患者的依从性偏低,而与性别无明显相关性。导致患者自行停药的主要原因有经济条件、害怕药物副作用、主观健康意识不高、吃药看不到效果。结论 我院目前缺血性脑血管病合并房颤患者二级预防依从性不高,应引起足够重视,在今后的工作中应该加强患者教育,完善随访体系,提高患者依从性,减少卒中复发。Objective To evaluate the effect of secondary prevention drugs in patients with ischemic cerebrovascular disease combined with nvAF,and analyze the factors affecting their compliance,in order to provide reference for secondary prevention drugs in patients with ischemic cerebrovascular disease combined with NVAF.Methods From January 2018 to December 2020,one hundred and ninety-eight patients with ischemic cerebrovascular disease with no-valvular atrial fibrillation are collected in Tangshan Workers’ Hospital.All patients underwent 12 months of outpatient or telephone follow-up.Registered the patient’s medication status,recorded the patient’s medication status,reasons for drug withdrawal,clinical events,and the effect of secondary prophylactic drugs.At last,the factors affecting patients’ compliance with secondary preventive drugs were analyzed.Results There was statistically significant difference in medication compliance of 169 patients who took the anti-platelet drugs at 3 months vs6 months and 3 months vs 12 months after discharge(P0.05).There is no significant difference in compliance of warfarin,anti-hypertensive drugs and hypoglycemic drugs at each follow-up time point(P>0.05).There is a significant difference in compliance of lipid-lowering drugs at each follow-up time point(P<0.05).In terms of antithrombotic drug compliance of 198 patients 12 months after discharge,140 patients(70.70%) had high compliance,while 58 patients(29.30%) had low compliance.Through this study,it was found that advanced age,low education level,lack of health insurance,low income level,lack of follow-up review on time,lack of standardized and reasonable patient education,and dependence on patients’ family members for drug administration would all lead to low compliance of patients,and there was no significant correlation with gender.Conclusion At present,the compliance of secondary prevention in patients with ischemic cerebrovascular disease complicated with atrial fibrillation in our hospital is not high,which should be p

关 键 词：缺血性脑血管病 房颤 二级预防药物 依从性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]