佛山市顺德区乡镇地区脑卒中二级预防实施状况前瞻性研究

Secondary stroke prevention status in Shunde township area, Foshan:a prospective study

目的研究佛山顺德区乡镇地区脑卒中患者二级预防实施状况及其影响因素。方法对2012年1月1日至2012年12月31日在佛山市顺德区均安医院门诊及住院诊治的新发脑卒中患者进行登记,在离院后1年的时间点通过电话随访获得就诊行为及用药等情况。结果研究期间共登记病例289例,其中缺血性脑卒中220例,占76.1%,出血性卒中69例,占23.9%。入选患者238例,有效随访216例。定期复诊组抗栓药物、降压药物、降糖药物及他汀类药物使用率分别为79.6%、88.6%、83.3%及82.0%,非定期复诊组则分别为11.4%、16.4%、25.0%及12.4%。两组间差异有统计学意义(P均<0.05)。1年后未定期复诊的原因包括:不清楚二级预防重要性(68.8%)、医生未告知或建议(45.2%)、无医保或无力支付(31.8%)、行动不便或缺少家庭支持(24.2%)。结论佛山市顺德区乡镇地区脑卒中二级预防实施状况欠理想。加强基层地区学科建设、提升卒中健康教育质量可能改善脑卒中患者二级预防质量。

Objective To investigate the secondary stroke prevention status in Shunde township area, Foshan. Methods Patients diagnosed as stroke at Jun′ an hospital, Shunde district, Foshan, from Jan. 1 to Dec. 31 in 2012 were registered. Structured telephone interviews were performed to investigate the status of secondary prevention 1 year after diagnosed with stroke. Results There were 289 patients diagnosed as stroke during the study, including 220 patients with ischemic stroke and 69 with hemorrhagic stroke. 238 patients met the recruiting criteria, and 216 patients were effectively followed up through telephone interview. In the regular follow up group,the administration rates with antithrombotics, antihypertensive agents, antidiabetic agents and statins were 79.6%,88.6%,83.3% and 82.0%,respectively, significantly higher than those in irregular follow up group（11.4%, 16.4%, 25.0% and 12.4%; χ2=88.5962, P 〈0.05, χ2=72.0714, P 〈0.05, χ2=11.6965, P 〈0.05, χ2=49.5592, P 〈0.05）. Reasons for poor compliance with secondary stroke prevention included low awareness of importance（68.8%）, physicians not informing（45.2%）, not having medical insurance or being unable to afford（31.8%）,and being disabled or lack of family support（24.2%）.Conclusion This study suggested a poor status of secondary stroke prevention in Shunde township area, Foshan.Enforcing health education on stroke and health care infrastructure may improve secondary stroke prevention.