出院冠心病患者抗血小板治疗依从状况及影响因素分析

Status of Compliance to Antiplatelet Therapy in Discharged Patients with Coronary Heart Disease and Analysis on the Influencing Factors

目的研究出院冠心病患者抗血小板治疗依从状况及影响因素。方法选取2012年9月至2013年12月于上海市交通大学附属第六人民医院心血管内科治疗的冠心病患者348例为研究对象,评估患者出院后服用抗血小板药物的依从性及其影响因素、分析其停药原因;并初步探讨依从性对主要不良心脏事件(MACE)发生的影响。结果患者出院后3个月、6个月及1年依从服用抗血小板药物的患者分别占98.3%(342/348)、92.8%(323/348)及81.9%(285/348)。多因素分析结果显示,年龄(OR=1.671,P=0.000)、文化程度(OR=1.278,P=0.003)及经皮冠状动脉介入(PCI)(OR=2.012,P=0.008)是影响患者服药依从性的主要因素。随访期间依从抗血小板治疗患者的累计MACE发生率为3.4%(10/291),显著低于非依抗血小板治疗患者[12.7%(8/63)],差异有统计学意义(P<0.01)。结论冠心病患者出院后抗血小板治疗存在非依从问题,影响患者的预后,医护人员应根据患者的年龄、文化程度及是否行PCI治疗制订干预措施,以提高患者出院后的服药依从性。

Objective To study the compliance to antiplatelet therapy in patients with coronary heart disease and its influencing factors. Methods Total of 348 coronary heart disease patients in Cardiology Department of the Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University from Sep. 2012 to Dec. 2013 were included in the study. The compliance to antiplatelet drugs, the influeneeing factors and major ad- verse cardiac events（MACE） were evaluated in patients after discharge. Results Three months, six months and one year after discharge, the compliance to antiplatelet drugs in patients were 98.3% （342/348）, 92.8% （323/348） and 81.9% （ 285/348 ） respectively. Multivariate analysis showed that the main factors affecting compliance were the age （ OR = 1.671, P = 0, 000 ） , educational level （ OR = 1. 278, P = 0. 003 ） and percutaneous eoronany intervention （PC1） （ OR = 2. 012, P = 0. 008 ）. Cumulative MACE rate in patients with good compliance of anti-platelet therapy was 3.4% （ 10/291 ） , significantly lower than patients with non- compliance of antiplatelet therapy＇s 12. 7% （8/63）, the difference was statistically significant （P 〈 0. 01 ）. Conclusion After discharge, non-compliance to antiplatelet therapy exists in the coronary heart disease patients and affects the prognosis. Health care interventions should be developed according to the patient＇s age, education level, and whether treated with PCI,in order to improve the compliance after discharge.