非心源性卒中患者出院抗血小板药物应用现状及影响因素

Application situation and influencing factors of antiplatelet drugs in non-cardiac ischemic stroke patients at discharge

目的 本研究旨在评估中国城市29家医院非心源性性卒中患者出院时抗血小板药物应用情况及影响因素.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非心源性卒中患者人口学信息、既往史、出院抗血小板药物应用及医院资源信息,明确抗血小板药物应用情况及影响因素.结果 2011-03-01-03-31 29家二级或三级医院神经内科出院的994例非心源性卒中患者,出院时抗血小板药物应用率94.37%.抗血小板药物应用最多的是阿司匹林（59.27%）.多因素分析显示,女性（OR=0.530,95% CI 0.302～0.930,P=0.0269）、脑出血史（OR=0.131,95% CI 0.040～0.430,P=0.0008）、消化道出血史（OR=0.085,95% CI 0.034～0.210,P＜0.0001）与未应用抗血小板药物有关.结论 中国城市非心源性卒中患者抗血小板药物应用率相对不足,应加以改进,并合理规范应用.

Objective To evaluate the antiplatelet drugs prescription at discharge in patients with non-cardiac ischemic stroke, and to identify influencing factors for prescription in 29 hospitals in China. Methods The investigation was multicentre cross-sectional study. We prospectively collected demographic information, past history, antiplatelet drug prescription at discharge and hospital medical resources information. Results We prospectively reviewed the medical records of all patients who were discharged from the neurological department with the diagnosis of non-cardiac ischemic stroke from Mar. 1 to Mar. 31 in 2011. Nine hundred and ninety-four ischemic stroke patients of non-cardiac origin were assessed. 94.37% of patients were prescribed antiplatelet drugs at discharge. Aspirin prescription ration was the highest （59.27 %） in patients who were prescribed antiplatelet drug. Multivariate analysis showed female （OR = 0. 530, 95 〈 CI 0. 302 〈 0. 930, P = 0. 0269）, cerebral hemorrhage （OR= 0. 131,95 〈/00 CI 0. 040 〈0. 430, P = 0. 0008） and alimentary tract hemorrhage （OR = 0. 085,95 % CI 0. 034 0. 210, P〈0. 0001） were related with no antiplatelet drug prescription. Conclusion The antiplatelet drug prescription is inade- quate in non-cardiac ischemic stroke patients in China. Monitoring and improvement should be promoted.