上海市青浦地区缺血型脑卒中二级预防用药依从性及影响因素

Compliance status and influencing factors of secondary prevention of ischemic stroke in Qingpu District of Shanghai

目的随着社会老龄化,缺血性脑卒中患者日益增多,良好的二级预防可减少卒中复发,本研究旨在了解青浦地区缺血性脑卒中患者二级预防用药依从性及其影响因素,以提高青浦地区患者二级预防依从性。方法纳入2015-07-01-2017-06-30因缺血性脑卒中在复旦大学附属中山医院青浦分院神经内科住院的300例患者,通过电话或卒中门诊随访,了解缺血性脑卒中二级预防用药依从性现状,分析年龄、性别、受教育年限、随访时间、既往史、改良Rankin量表(modified rankin scale,mRS)评分、有无照顾者及随访医院级别等基本资料与患者用药依从性之间的相关性,并对影响药物依从性的原因进行分析。结果215例患者完成随访,脑梗死复发率为19.1%。依从性好者122例(56.7%),依从性不好者93例(43.2%)。单因素分析结果显示,有无照料者(χ2=20.995,P<0.001)、受教育年限(χ2=20.144,P<0.001)、卒中预后(χ2=7.002,P=0.008)、随访医院级别(χ2=9.484,P=0.009)和卒中复发(χ2=12.940,P<0.001)对患者药物依从性影响有统计学意义。多因素分析结果显示,有无照料者(OR=0.138,95%CI为0.054~0.353,P<0.001)、受教育年限(OR=0.281,95%CI为0.145~0.543,P<0.001)、随访医院级别(OR=0.461,95%CI为0.233~0.914,P=0.027)以及卒中是否复发(OR=9.398,95%CI为2.417~36.538,P=0.001)与依从性有关。结论青浦地区缺血性脑卒中患者二级预防用药依从性相对较低,其中文化程度较低、无照料者及有缺血性脑卒中复发患者服药依从性差,应重视和规范青浦社区医生在卒中预防与诊治方面的能力培养。

OBJECTIVE With the aging of the society,the number of patients with ischemic stroke is increasing.Good secondary prevention can reduce the recurrence of stroke.The purpose of this study was to understand the secondary prevention drug compliance of patients with ischemic stroke in Qingpu area and its influencing factors,so as to improve the secondary prevention compliance of patients.METHODS From July 1,2015 to June 30,2017,a total of 300 patients who were hospitalized in the Department of Neurology of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University due to ischemic stroke were selected as the research objects.Through telephone or outpatient follow-up of stroke,the current situation of compliance of secondary prevention drugs for ischemic stroke was understood.Age,gender,years of education,follow-up time,past history and modified Rankin scale were analyzed.The correlation between scale,Mrs score,caregivers and follow-up hospital level and drug compliance was analyzed.RESULTS A total of 215 patients were followed up,the recurrence rate of cerebral infarction was 19.1%.Totally 122 cases(56.7%)had good compliance and93 cases(43.2%)had poor compliance.Single factor analysis showed that whether there were caregivers(χ2=20.995,P<0.001),years of education(χ2=20.144,P<0.001),stroke prognosis(χ2=7.002,P=0.008),follow-up hospital level(χ2=9.484,P=0.009)and stroke recurrence(χ2=12.940,P<0.001)had statistically significant effects on patients’drug compliance.The results of multivariate analysis showed that compliance was related to the number of caregivers(OR=0.138,95%CI:0.054-0.353,P<0.001),years of education(OR=0.281,95%CI:0.145-0.543,P<0.001),hospital level of follow-up(OR=0.461,95%CI:0.233-0.914,P=0.027),and recurrence of stroke(OR=9.398,95%CI:2.417-36.538,P=0.001).CONCLUSION Poorer compliance tends to be found in ischemic stroke patients with lower level of education,no caregivers and stroke recurrence.The competence training of stroke prevention,diagnosis and treatment shall be strengthened and regulated to community doctors.