缺血性卒中患者他汀类药物治疗依从性调查及原因分析

Survey and analysis of the applicatiaon and compliance of statins in the patients with ischemic stroke

目的观察缺血性卒中二级预防中他汀类药物的应用现状，分析影响其依从性的因素。方法选取2011年12月至2012年10月连续入院的缺血性卒中患者，收集其临床特征及可能影响他汀类药物依从性的因素，随访发病后3个月时的应用情况，采用多元Logistic回归进行统计学分析。结果368例患者住院期间有67．9％（250／368）的患者应用他汀类药物。他汀类药物在高危、极高危Ⅱ及极高危I的指南符合率分别为28．1％（18／64）、44．1％（30／68）和72．3％（136／188），多元Logistic回归分析发现住院期间使用他汀类药物与颈动脉易损斑块（OR=5．308，P=0．000）及糖尿病病史相关（OR=1．789，P=0．032）。3个月时他汀类药物总体应用率为22．6％（82／363），出院医嘱规范者用药依从性高。结论他汀类药物应用与指南存在差距，标准出院医嘱能够提高用药的依从性。

Objective To investigate the application of statins in secondary prevention of ischemic stroke in different risk groups, and to identify the factors influencing the complicance of statins. Methods Ischemie stroke patients from December 2011 to October 2012 were collected. All clinical characterisitcs and possible factors influencing the compliance of statins was recorded in 3 months. The multivariate Logistic regression analysis was used to analyze the influencing factors of the compliance of statins. Results All 368 patients were collected, and 67.9%（250/368 ） patients were prescribed statins for therapy during hospitalization. The application rate of statins in accordance with guidelines in high-risk, extremely high-risk Ⅱ and extremely high-risk I patients was 28.1% （18/64）,44.1% （30/68） and 72.3% （136/188）,respectively. Logistic regression analysis showed that the statins application during hospitalization was associated with the presence of carotid vulnerable plaques （ OR = 5.308, P = 0.000 ） and diabetes history （ OR = 1.789, P = 0.032 ）. Routine discharge instructions had high compliance. Conclusion The compliance of statins in secondary prevention of ischemic stroke still has a large gap between clinical practice and guidelines, and routine discharge instructions on statins application increase the compliance of statins.