缺血性卒中患者出院降压药物应用现状及其影响因素

Application Situation and Influencing Factors of Antihypertensive Drugs in Ischemic Stroke Patients at Discharge

目的本研究旨在评估中国城市2g家医院缺血性卒中(ischemic stroke,IS)合并高血压病患者出院时降压药物应用情况及其影响因素。方法本调查为多中心横断面研究,通过连续收集诊断明确的IS患者人口学信息、既往病史、出院降压药物应用及医院资源信息,进行统计分析。结果 2011年3月1～31日期间,29家Ⅱ级或Ⅲ级医院神经内科出院的IS患者,893例合并高血压病,出院时降压药物应用率73.35%,处方一种降压药比例为41.99%。应用的降压药物中,比例最高的是钙离子拮抗剂(54.54%)。多因素分析后显示心房颤动[比值比(odds ratio,0R)0.39;95%可信区间(confidence interval,CI)0.22～0.68;P=0.0009]、心功能不全病史(OR 0.32;95%CI 0.15～0.65;P=0.0017)与应用降压药物有关,而未成立卒中单元(OR 1.98;95%CI 1.42～2.75;P<0.0001)及神经内科病床<70张(OR 1.57;95%CI 1.12～2.19;P=0.0080)与未应用降压药物有关。结论中国城市卒中合并高血压患者降压药应用率相对不足,应加以改进提高,并合理规范应用。

Objective To evaluate the antihypertensive drugs prescription at discharge in patients with ischemic stroke and hypertension, and to identify influencing factors for prescription in 29 hospitals in China. Methods The investigation was a multicentre cross-sectional study. We prospectively collected demographic information, past history, antihypertensive drug prescription at discharge and hospital medical resources information. Results We prospectively reviewed the medical records of all patients who were discharged from the neurology department with the diagnosis of ischemic stroke from Mar. 1 to Mar. 31 in 2011. Eight hundred and ninety-three ischemic stroke patients with hypertension were assessed. 73.35% of patients were prescribed antihypertensive drugs at discharge. Calcium channel blocker prescription ration was the highest（54.54%） in patients who were prescribed one antihypertensive drug. Multivariate analysis showed atrial fibrillation（OR 0.39; 95%CI 0.22-0.68; P=0.0009） and heart failure（OR 0.32; 95%CI 0.15-0.65; P=0.0017） were related with antihypertensive drug prescription, while no stroke unit（OR 1.98; 95%CI1.42-2.75; P〈0.0001） and the number of hospital beds of neurological department 〈70（OR 1.57; 95%CI 1.12-2.19; P=0.0080） were related with no antihypertensive drug prescription. Conclusion The antihypertensive drug prescription was inadequate in ischemic stroke patients with hypertension in China. Monitoring and improvement should be promoted.