冠心病患者出院后一年抗血小板药物治疗依从行为及其影响因素分析

Analysis of the compliance and affective factors about antiplatelet therapy in patients with coro- nary heart disease one year after hospitalization

目的探讨安徽省某三甲医院冠D病患者出院后1年抗血小板药物治疗依从行为及其影响因素，为冠心病患者的二级预防提供依据。方法选取2012年1—12月在安徽省某三甲医院被首次确诊（冠状动脉造影方法）为冠心病的患者398例（最终363例完成研究），通过自行设计的问卷在出院后1年时进行电话或门诊随访，评估患者出院后1年时的抗血小板药物服用依从情况、不依从原因、药物相关不良反应等。采用Logistic回归分析法，分析影响冠心病患者服用抗血小板药物依从性的因素。结果冠心病患者出院后1年时服用抗血小板药物的情况：依从服药301例（83％，301／363），不依从服药62例（17％，62／363）；影响抗血小板药物治疗依从性的因素：年龄、医疗付费方式、是否经皮冠状动脉介入治疗（PCI）、冠心病类型（稳定型心绞痛、不稳定型心绞痛及急性心肌梗死），x^2值分别为9．425、6．262、5．556和6．895，差异均有统计学意义。其中，年龄【OR值为0．471（0．284～0．782）】、是否PCⅡDR值为2．104（1．123-3．942）提影响冠心病患者抗血小板药物治疗依从性的主要因素。结论冠心病患者出院后1年抗血小板药物治疗存在非依从问题，医护人员应根据患者的年龄、是否PCI治疗制订治疗方案及护理干预措施，以强化用药信念行为，提高服药依从性，做好冠心病患者的二级预防。

Objective To analyze the compliance of antiplatelet therapy and its affective factors in patients with coronary heart disease one year after hospitalization,which will improve the secondary preven- tion for coronary heart disease. Methods The study enrolled 398 patients （363 patients completed the study） with first-diagnosed coronary heart disease in a provincial hospital in Anhui province from Jan- uary to December 2012. The therapeutic compliance of these patients, as well as the affective factors, were evaluated with a self-designed questionnaire either through phone revisit or out-patient interview. The factors influencing therapeutic compliance of patients with coronary heart disease were analyzed by Logistic regression analysis. Results The results showed 301 （83%） patients were in a good therapeutic compliance, while the rest of 62 （17%） patients were not. The affective factors included age, ways of medical payment, whether with PCI treatment or not, and the types of coronary heart disease （stable angina, unstable angina and acute myocardial infarction）,X^2 values were 9.425, 6.262, 5.556 and 6.895. The main affective fac- tors were the age [ OR=0.471（0.28d--0.782） ] and whether with PCI therapy or not [ OR=2.104（1.123-3.942） ]. Conclusions Patients had poor compliance of antiplatelet therapy one year after hospitalization, medical staffs should make treatment protocol and nursing measures according to age and whether with PCI treat- ment or not of patients, so that the belief and behavior of medication can be intensified, the medication compliance can be elevated and the secondary prevention can be well implemented.