中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
10期
1060-1063
,共4页
郝冬琳%吴波娜%王利惠%许元丰%王佳佳%刘志清%马爱金
郝鼕琳%吳波娜%王利惠%許元豐%王佳佳%劉誌清%馬愛金
학동림%오파나%왕리혜%허원봉%왕가가%류지청%마애금
药物疗法%卒中%服从预先规定
藥物療法%卒中%服從預先規定
약물요법%졸중%복종예선규정
Drug therapy%Stroke%Advance directive adherence
目的 调查常州地区缺血性脑卒中复发高危患者二级预防药物的应用情况. 方法 分析2010 2011年在我院住院的300例急性非心源性缺血性脑卒中患者的临床资料,卒中复发高危风险定义为艾森卒中风险评分量表(ESRS)≥3分,比较ESRS不同得分其构成参数的情况.出院时均给予规范的缺血性卒中二级预防指导,随访3个月、1年,调查抗血小板治疗、危险因素药物治疗(降压、降糖治疗)及调脂治疗的使用情况及依从性. 结果 在ESRS评分的参数中,除年龄(x2=126.54,P=0.000)、既往短暂性脑缺血发作(TIA)或缺血性卒中(x2=21.27,P=0.000)这两个危险因素在不同得分患者中差异有统计学意义,高血压、糖尿病、既往心肌梗死、其他心脏疾病、吸烟等危险因素在不同得分患者中的差异无统计学意义(均P＞0.05).出院时抗血小板治疗率为98.3％(295/300),降压、降糖药物使用率分别为95.0％ (255/268)及l00％ (72/72),他汀类药物使用率达到99.0％(297/300).3个月后,降压、降糖治疗的依从性最好,分别为88.1％(222/252)、86.2％(56/65);抗血小板药物治疗的依从性次之,其中阿司匹林使用率较高为82.0％ (228/278),氯吡格雷使用率较低为6.1％ (17/278);调脂药物治疗的依从性最差为60.1％ (167/278).1年后,危险因素药物治疗的依从性较3个月时提高,分别为89.9％(220/245)、93.4％(57/61),但差异无统计学意义(均P＞0.05);抗血小板(阿司匹林、氯吡格雷)治疗及调脂治疗依从性亦较3个月时提高,分别93.2％(245/263)、30.8(81/263)、88.9％ (234/263),差异有统计学意义(均P＜0.01),且抗血小板治疗中氯吡格雷使用率增加. 结论 常州地区缺血性脑卒中复发高危患者二级预防药物治疗已取得一定成效,长期随访并建立良好的医患沟通可提高二级预防药物治疗的依从性,提高缺血性脑卒中复发高危患者抗血小板药物的使用率.
目的 調查常州地區缺血性腦卒中複髮高危患者二級預防藥物的應用情況. 方法 分析2010 2011年在我院住院的300例急性非心源性缺血性腦卒中患者的臨床資料,卒中複髮高危風險定義為艾森卒中風險評分量錶(ESRS)≥3分,比較ESRS不同得分其構成參數的情況.齣院時均給予規範的缺血性卒中二級預防指導,隨訪3箇月、1年,調查抗血小闆治療、危險因素藥物治療(降壓、降糖治療)及調脂治療的使用情況及依從性. 結果 在ESRS評分的參數中,除年齡(x2=126.54,P=0.000)、既往短暫性腦缺血髮作(TIA)或缺血性卒中(x2=21.27,P=0.000)這兩箇危險因素在不同得分患者中差異有統計學意義,高血壓、糖尿病、既往心肌梗死、其他心髒疾病、吸煙等危險因素在不同得分患者中的差異無統計學意義(均P＞0.05).齣院時抗血小闆治療率為98.3％(295/300),降壓、降糖藥物使用率分彆為95.0％ (255/268)及l00％ (72/72),他汀類藥物使用率達到99.0％(297/300).3箇月後,降壓、降糖治療的依從性最好,分彆為88.1％(222/252)、86.2％(56/65);抗血小闆藥物治療的依從性次之,其中阿司匹林使用率較高為82.0％ (228/278),氯吡格雷使用率較低為6.1％ (17/278);調脂藥物治療的依從性最差為60.1％ (167/278).1年後,危險因素藥物治療的依從性較3箇月時提高,分彆為89.9％(220/245)、93.4％(57/61),但差異無統計學意義(均P＞0.05);抗血小闆(阿司匹林、氯吡格雷)治療及調脂治療依從性亦較3箇月時提高,分彆93.2％(245/263)、30.8(81/263)、88.9％ (234/263),差異有統計學意義(均P＜0.01),且抗血小闆治療中氯吡格雷使用率增加. 結論 常州地區缺血性腦卒中複髮高危患者二級預防藥物治療已取得一定成效,長期隨訪併建立良好的醫患溝通可提高二級預防藥物治療的依從性,提高缺血性腦卒中複髮高危患者抗血小闆藥物的使用率.
목적 조사상주지구결혈성뇌졸중복발고위환자이급예방약물적응용정황. 방법 분석2010 2011년재아원주원적300례급성비심원성결혈성뇌졸중환자적림상자료,졸중복발고위풍험정의위애삼졸중풍험평분량표(ESRS)≥3분,비교ESRS불동득분기구성삼수적정황.출원시균급여규범적결혈성졸중이급예방지도,수방3개월、1년,조사항혈소판치료、위험인소약물치료(강압、강당치료)급조지치료적사용정황급의종성. 결과 재ESRS평분적삼수중,제년령(x2=126.54,P=0.000)、기왕단잠성뇌결혈발작(TIA)혹결혈성졸중(x2=21.27,P=0.000)저량개위험인소재불동득분환자중차이유통계학의의,고혈압、당뇨병、기왕심기경사、기타심장질병、흡연등위험인소재불동득분환자중적차이무통계학의의(균P＞0.05).출원시항혈소판치료솔위98.3％(295/300),강압、강당약물사용솔분별위95.0％ (255/268)급l00％ (72/72),타정류약물사용솔체도99.0％(297/300).3개월후,강압、강당치료적의종성최호,분별위88.1％(222/252)、86.2％(56/65);항혈소판약물치료적의종성차지,기중아사필림사용솔교고위82.0％ (228/278),록필격뢰사용솔교저위6.1％ (17/278);조지약물치료적의종성최차위60.1％ (167/278).1년후,위험인소약물치료적의종성교3개월시제고,분별위89.9％(220/245)、93.4％(57/61),단차이무통계학의의(균P＞0.05);항혈소판(아사필림、록필격뢰)치료급조지치료의종성역교3개월시제고,분별93.2％(245/263)、30.8(81/263)、88.9％ (234/263),차이유통계학의의(균P＜0.01),차항혈소판치료중록필격뢰사용솔증가. 결론 상주지구결혈성뇌졸중복발고위환자이급예방약물치료이취득일정성효,장기수방병건립량호적의환구통가제고이급예방약물치료적의종성,제고결혈성뇌졸중복발고위환자항혈소판약물적사용솔.
Objective To investigate the application of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city,analyze the reasons for decreased medication compliance,and evaluate the current secondary prevention medication.Methods We investigated 300 consecutive hospitalized patients with acute non-cardiogenic and ischemic stroke high risk.High risk of recurrent stroke was defined as ESSEN Stroke Risk Score (ESRS) ≥3.Different ESRS scales consisting of different parameters were analyzed.All of the patients received standard secondary prevention of ischemic stroke at discharge.After three months and a year follow up,antiplatelet therapy,therapy of risk factors (hypertension and diabetes mellitus),lipid lowering therapy,and medication compliance were investigated.Results Except for age (x2 =126.54,P =0.000) and previous cerebral ischemic stroke or transient ischemic attack (TIA) (x2 =21.27,P =0.000),there were no significant differences in other risk factors (hypertension,diabetes,previous myocardial infarction,heart diseases,smoke) in patients with different ESRS scale scores (all P＞ 0.05).Antiplatelet therapy utilization was 98.3％ (295/300),antihypertensive and antidiabetic drug use rates were 95.0％(255/268) and 100％(72/72),statin use rate reached to 99％ (297/300) at discharge.After three months follow up,medication compliance in hypertension and diabetes mellitus therapy was the best [88.1％(222/252)and 86.2％ (56/65)],followed by aspirin [82.0％ (228/278)],and clopidogrel [6.1％ (17/278)].The medication compliance in lipid lowering therapy was the worst [60.1％ (167/278)].After a year follow-up versus the previous three-month follow-up,the medication compliance in hypertension and diabetes mellitus therapy was increased,but had no significant difference [89.9 ％ (220/245) vs.88.1％ (222/252),93.4％(57/61)vs.86.2％(56/65),P＞0.05],and the medication compliances inantiplatelet therapy with aspirin and clopidogrel,and lipid lowering therapy were increased significantly [93.2％ (245/263)vs.82.0％ (228/278),30.8(81/263) vs.6.1％ (17/278),88.9％ (234/263) vs.60.1％ (167/278),all P＜0.01].The increment of use rate was higher in clopidogrel therapy than in aspirin therapy.Conclusions The secondary prevention medication achieves certain efficacies in patients with high risk of recurrent ischemic stroke in changzhou city.Long term follow-up and good communication between doctor and patient can effectively improve the medication compliance in secondary prevention,and can increase the use rate of antiplatelet therapy in patients with high risk of recurrent ischemic stroke.
