提高缺血性脑卒中患者二级预防中抗血小板药物治疗的依从性研究

Improvement of antiplatelet therapy compliance in secondary prevention of ischemic stroke

目的以指南培训为干预手段,考评海南省缺血性脑卒中患者二级预防中抗血小板药物治疗状况改善情况。方法调查2011年1月~2012年3月在海南省10家二级或三级综合性医院再次住院的1300例缺血性脑卒中患者抗血小板药物的应用情况;10家医院参与课题研究并对相关医师进行技术培训;2015年再次对该群患者1279例(脱落21例)对比调查、评估抗血小板药物的应用状况;分析干预前后患者抗血小板药物治疗的改善情况。结果干预后,缺血性脑卒中患者二级预防中抗血小板聚集药物治疗的知晓率和治疗率均显著提高,2011年知晓率60.4%,治疗率49.2%,2015年知晓率86.5%,治疗率76.9%(P<0.01)。使用剂量过小和中断服药的比例显著降低,2011年剂量过小20.1%,中断服药5.3%,2015年剂量过小2.7%,中断服药3.5%(P<0.05,P<0.01)。10家医院神经内科医师抗血小板药物治疗知识测试评分显著提高,2011年为(55.6±10.7)分,2015年为(78.2±15.5)分(P<0.01)。2015年二级医院与三级医院抗血小板药物治疗差异消失(r=0.092,P=0.405)。结论课题研究和指南培训改善了缺血性脑卒中患者二级预防中抗血小板药物治疗的现状,缩小了不同级别医院的差距。

Objective To investigate the improvement of antiplatelet therapy for secondary prevention of ischemic stroke（IS）in Hainan Province.Methods Application of antiplatelet therapy was investigated in 1300 IS patients readmitted to 10 class B or A hospitals of Hainan Province from January 2011 to March 2012.Physicians involved in scientific project of 10 hospitals were trained.Application of antiplatelet therapy in 1279 patients was investigated once more in 2015.The improvement of antiplatelet therapy was analyzed.Results The awareness rate and curative rate of antiplatelet therapy for second prevention of IS were significantly increased in IS patients,accounting for 60.4% and 49.2%in 2011,86.5% and 76.9%in 2015（P〈0.01）.The low dose/drug withdrawal ratio was significantly decreased,accounting for 20.1%and 5.3%in 2011,2.7%and 3.5%in 2015（P〈0.05,P〈0.01）.The knowledge test score of antiplatelet drugs was significantly increased in neurologists of 10 hospitals,which was 55.6in 2011 and 78.2in 2015（P〈0.01）.The difference in antiplatelet therapy for second prevention of IS was disappeared in class B and A hospitals（r=0.092,P=0.405）.Conclusion Involvement in scientific project and guideline training can improve antiplatelet therapy for secondary prevention of IS and reduce the gap between hospitals at different levels.