北京社区冠心病患者阿司匹林应用状况分析

Survey on aspirin application for secondary prevention of coronary artery disease in Beijing communities

目的 了解基层社区冠心病患者在二级预防中的阿司匹林使用情况及其原因。 方法 采用横断面问卷调查的方式,于2014年9月至2015年1月由北京市60家社区卫生服务中心全科医生对就诊的冠心病患者进行阿司匹林使用现状进行调查,分析患者服药持续时间、服用剂量、服药时间、中途停药原因、未使用原因等情况。 结果 共发放调查问卷61 000份,收回问卷56 969份(有效回收率93.39%)。其中冠心病患者20 931例。有≥1条诊断依据的冠心病患者中78.22%(15 105/19 311)服用阿司匹林,自报冠心病而无诊断依据者中81.42%(1 319/1 620)应用阿司匹林,两者间差异有统计学意义(χ^2=9.06,P<0.01)。有无早发心血管家族史的有诊断依据冠心病患者的阿司匹林使用率差异无统计学意义(P=0.77)。有冠心病诊断依据而未服用阿司匹林的患者中汇报原因按比例由高至低分别为:不明原因的拒绝、担心胃肠道反应、已服用氯吡格雷、不是阿司匹林适用人群、服用其他抗血小板药物。 结论 北京基层社区卫生机构中就诊的冠心病患者整体阿司匹林服用比例较高,未服用阿司匹林的患者主要原因集中于患者主观拒绝和担心胃肠道不良反应方面,这仍将是未来冠心病二级预防治疗宣教的重点。

Objective To survey the status of aspirin application asantiplatelet therapy for secondary prevention of coronary artery disease (CAD) in Beijing communities. Methods A cross-sectional survey on status of aspirin use was conducted among 60 communities in Beijing from September 2014 to January 2015. Items of survey included the duration of aspirin application, aspirin dosage, application time, reasons for interruption and reasons for non-application. Results Total 61 000 questionnaires were delivered and 56 969 valid ones were retrieved with a recovery of 93.39%. The aspirin application rate was 78.22% (15 105/19 311) among patients with diagnosed CAD, while that was 81.42% (1 319/1 620) among patients with self-reported CAD (χ^2=9.06, P<0.01). There was no effect of early cardiovascular disease family history on aspirin application among patients with diagnosed CAD (P=0.77). Among the patients with diagnosed CAD, the reasons of no aspirin application were: rejection with unknown reasons, worry about stomach side effects, clopidogrel application, not suitable subjectsand other antiplatelet drugs application. Conclusions The proportion of aspirin application is relatively high among coronary artery disease patients in Beijing communities. The results of survey provide the direction of patient education in the future.