阿司匹林和氯吡格雷双联抗血小板治疗心脏介入术后患者在社区随访的意义

Significance of Community Follow-up of the Patients Receiving Dual Antiplatelet Therapy of Aspirin and Clopidogrel after Cardiac Interventions

目的 研究阿司匹林和氯吡格雷双联抗血小板治疗在社区卫生服务中心就诊患者中的依从性、并发症及其在社区卫生服务中心应用的意义.方法 选取2012年3月至2013年3月在上海市虹口区欧阳路街道社区卫生服务中心（社区中心）门诊就诊的服用阿司匹林和氯吡格雷双联抗血小板治疗的患者120例,社区中心给予口服拜阿司匹林每日1片（100 mg/片）,同时加服氯吡格雷每日1片（75 mg/片）,进行随访分析.结果 120例随访患者中男83例、女37例,年龄44～ 90（69.3±6.4）岁,在随访的人群中出血率和再入院率仅为3.33％,出血主要为消化道出血（3例）和脑出血（1例）,120例随访患者社区中心随访1年用药费用显著低于本市三级医院一年用药费用[（1845.55±1064.89）元vs（3029.27±826.94）元],差异有统计学意义（=8.749,P＜0.001）.结论 经过三级医院对心血管疾病患者的治疗后,转至社区中心继续进行阿司匹林联合氯吡格雷双联抗血小板治疗,依从性好、费用经济、并发症低,值得推广.

Objective To analyze the patient compliance, complications and significance of applying dual antiplatelet therapy of aspirin and clopidogrel in the community healthcare service center. Methods A total of 120 patients who went to community healthcare service center from March 2012 to March 2013 and took aspirin one piece（ 100 mg/pill） per day and plavix one piece （75 mg/pill ） per day were selected, followed up and analyzed. Results Among the 120 cases followed up,83 males and 37 females,aged 44 to 90 years, mean age （ 69.3 ± 6.4 ） years, during the follow-up, bleeding rate and readmission rate was 3.33%, mainly were gastrointestinal bleeding bleeding（ 3 cases） and cerebral hemorrhage（ 1 case）. The medical costs of the 120 cases were significantly lower than the annual drug costs of tertiary hospitals in the city[ （ 1845.55 ± 1064.89） yuan vs （3029.27 ± 826.94 ） yuan ] （ t = 8. 749, P 〈 0. 001 ）. Conclusion After receiving the treatment in tertiary hospital, patients with cardiovascular disease transferred to community healtheare service center to receive dual antiplatelet therapy of aspirin and clopidogrel, has better compliance, less medical expense and lower ratio of complications, thus is worthy of spreading.