强化二级预防管理的缺血性脑卒中复发率研究

Research on recurrence rate of ischemic stroke after enhanced management of secondary prevention follow-up intervention

目的探讨二级预防随访干预对缺血性脑卒中复发的影响。方法采用前瞻性、单中心、随机对照的研究方法,自2012年12月至2013年9月,筛选并收集首发的、发病在30d内、依从性好的缺血性脑卒中住院患者,先根据卒中风险评分量表(ESRS)评分结果分层,由于在该研究开始前的预调查,符合高危险层的患者数量少,故高危层暂不作为短期内研究分析。低危、中危层分别再随机分成干预组和对照组,采取不同强度的干预,低危层干预组每月干预1次,中危层每月2次。干预内容包括积极宣教以期改变患者生活习惯,督促患者积极控制危险因素以及提高患者的服药依从性并给予指导,两层的对照组均不做任何干预。6个月后由另外的医师进行盲法随访评估,评估内容主要包括缺血性脑卒中复发及药物的服用、吸烟、危险因素控制等情况。结果低危层干预组114例(失访3例)及对照组110例(失访2例)缺血性脑卒中的复发率分别为6.3%和14.6%;中危层干预组113例(失访4例)及对照组115例(失访4例)缺血性脑卒中的复发率分别为7.3%和16.2%,差异均有统计学意义(P<0.05);低危层及中危层干预组的药物依从性(除降糖药外)、血脂的达标率和戒烟率高于对照组,其差异均有统计学意义(P<0.05)。结论积极强化随访干预改变患者生活习惯、提高患者服药依从性、积极控制危险因素是预防缺血性脑卒中复发切实可行并行之有效的方法。

Objective To explore the effectiveness of recurrence rate of ischemic stroke after enhancedmanagement of secondary prevention follow-up intervention.Method Hospitalized ischemic stroke patients within30days of symptom onset were prospectively collected from December2012to September2013,stratified by the EssenStroke Risk Score(ESRS)into low-risk(0-2)and middle-risk(3-6)subgroups,then randomized into interventiongroup and control group.The follow-up intervention included active health education,controlling risk factors and givingnecessary guidance on what medicine should be taken.The frequency of intervention was different in two subgroups,low-risk subgroup once a month,middle-risk subgroup twice a month.There was no any intervention in control group.Blinded follow-up evaluation including recurrence,medication taken,smoking,blood pressure,blood sugar,bloodlipids were conducted by another two doctors in six months.Results The recurrence rate of stroke in interventiongroup and control group were6.3%and14.6%in low-risk subgroup,7.3%and16.2%in middle-risk subgroupwhich showed statistically significant(P<0.05).Rates of lipids control,medication adherence,smoking cessationsignificantly higher in intervention group than that in control group,and there were statistically significant(P<0.05),although the rates of blood sugar control were a little higher in intervention group,no statistical significance was found.Conclusion Enhanced follow-up intervention is a practical and effective method for lowering stroke recurrence afterchanging life habits,positive control of risk factors and improving patients’medication adherence.Great efforts are stillneeded to be taken in the secondary prevention of stroke.