缺血性脑卒中患者二级预防中抗血栓药物使用现况调查

The cross-sectional study on use of antithrombotic drugs in secondary prevention of ischemic stroke

目的调查缺血性脑卒中患者二级预防中抗血栓药物的使用情况，并分析其影响因素。方法本研究为现况调查，其对象为在北京天坛医院神经内科门诊就诊既往诊断明确的脑梗死或短暂性脑缺血发作患者（发病后4周。5年），调查其近两周内的抗血栓药物使用情况及相关影响因素。依据患者是否使用抗血栓药物，将入选患者分为两组：即治疗组与未治疗组。结果符合入选标准的缺血性脑卒中患者共计669例，最后共有607例缺血性脑卒中患者进入本研究结果分析中。其中未接受抗血栓药物治疗者163例（26．9％）。使用阿司匹林的患者中438例，其中剂量25-40mg/d的患者152例（34．7％）。在抗血栓药物的影响因素方面，较好的日常生活能力OR=1．009，95％CI：1．002-1．017、医疗保险OR=1．822，95％CI：1．123-2．956、高血压OR=1．533。95％CI：1．030-2．282是脑卒中患者接受药物治疗的促进因素。结论缺血性脑卒中幸存者均应给予抗血小板药物或抗凝药物，除非预计患者不久将死亡或有严重的禁忌证，其用药剂量应遵循临床指南。

Objective To investigate the utilization status of antithrombotic drugs in ischemic stroke survivors for secondary prevention and to identify factors influencing such treatment. Methods The study was a crosssectional investigation. Patients with diagnosis of ischemic stroke or TIA（transient ischemia attack）, 4 week-5 years after onset, from the outpatient department of Beijing Tiantan Hospital were recruited. The use of antithrombotic drugs within the last 2 weeks in these patients and related influencing factors were investigated through interviews. Results 669 patients with a discharge diagnosis of TIA and ischemic stroke met the recruiting criteria,but 62 of them were excluded from the study （due to lack of adequate information）. Of the remaining 607 patients, 163（26.9%） had not received any antithrombotic drugs, and of 438（72%） patients who had received aspirin, 152（34.7% ） had taken 25 to 40mg/d. In respect of influencing factors, independent daily life ability（Barthel Index,BI 75 - 100; OR = 1.009,95% CI： 1.002 - 1.017）, medical insurance （ OR = 1.822,95% CI： 1. 123 - 2.956） and hypertension （ OR = 1.533,95% CI： 1.030 - 2.282） were associated with the use of antiplatelet or anticoagulant treatment. Conclusions All ischemic stroke survivors should be given antiplatelet drugs or anticoagulant agents, except in cases of extremely short life expectancy or substantial contraindications. Physicians should strengthen their efforts to instruct stroke patients to take antithrombotic drugs in more details.