缺血性卒中二级预防药物依从性研究

A study on medication in the secondary prevention of ischemic stroke

目的评估卒中单元医疗模式的建立后,卒中二级预防措施的成效。方法回顾性分析获得完整资料152例缺血性卒中患者;对比前瞻性分析2004年11月至2005年12月期间获得完整资料138例。电话随访所收集的患者出院后3个月的二级预防药物使用情况,包括抗栓药、他汀类药物。结果传统治疗组与卒中单元组相比,抗栓药使用比例由69.1%上升至87.7%,他汀类使用比例由17.1%上升至56.5%,差异有显著的统计学意义。结论卒中单元医疗模式的启动后,卒中二级预防的药物治疗情况有了一定的改善,但是临床实践和二级预防的指南之间仍存在明显的差距。

Objective To explore the quality of secondary prevention for ischemie stroke provided to patients before and after the start of Stroke Unit in Shanghai. MethodsRetrospective and prospective case note analysis, the retrospective cohort （before the program） had 152 patients with stroke discharged during Sep. 2003 and Oct. 2004 and the pro-spective cohort （after the program） had 138 patients with stroke discharged during Nov. 2004 and Dec. 2005. Data on up to consecutive cases submitted by Huashan hospital. Theantithrombotic and statins medication of patients and medication of risk factors （ hypertension , diabetes, hyperlipidemia ） was evaluated through structured telephone interviews.Results Anti-thrombotic medication and statins in the stroke unit cohort was higher than thetraditional cohort （87.7% versus 69.1%, 56.5% versus 17.1% ） at discharge. Patientswith hypertension or diabetes were more likely to have antithrombotic treatment 3 months after discharge in the prospective cohort （78.9% versus 54.2%, 84.6% versus 64.7% ）.Conclusions Stroke Unit promotes to improve medication in the secondary prevention of ischemic stroke, but there was still a gap between the practice and the guideline.