糖尿病患者卒中防治知识水平及影响因素研究

Knowledge of Stroke Prevention and Treatment and Associated Factors among Hospitalized Diabetic Patients:a Questionnaire Survey

背景糖尿病患者是卒中高危人群,是卒中防治工作的重要目标人群。既往研究提示卒中防治知识的正确认知可明显减少卒中就诊延误、提高卒中救治效率。目前有关糖尿病患者卒中防治知识认知特点的研究较少。目的了解糖尿病患者卒中防治相关知识水平并分析其影响因素。方法于2016年12月-2017年9月,选择在深圳市南山区人民医院内分泌科住院的500例糖尿病患者,采用自行设计的调查问卷,以面对面的方式进行问卷调查。调查内容主要包括调查对象的基本情况,卒中防治相关知识(如卒中的发生部位、常见危险因素、常见警示症状、急救处理、缺血性卒中溶栓治疗及可预防性等),以及期望的卒中相关知识获取途径。采用多因素逐步回归分析影响卒中相关知识得分的可能因素。共发放问卷500份,回收有效问卷435份,有效应答率87.0%。结果调查对象对卒中危险因素的知晓率为5.3%~80.7%。在可干预卒中危险因素中以高血压知晓率最高〔80.7%(351/435)〕,高同型半胱氨酸血症知晓率最低〔10.3%(45/435)〕;在不可干预因素中以年龄知晓率最高〔65.8%(286/435)〕,种族知晓率最低〔5.3%(23/435)〕。对常见卒中警示症状的知晓率为13.1%~76.8%,以对单侧肢体麻木或无力的知晓率最高〔76.8%(334/435)〕,对抽搐的知晓率最低〔13.1%(57/435)〕。76.6%(333/435)的调查对象在面临突发卒中症状时选择"拨打120,呼叫救护车"。15.4%(67/435)调查对象知晓急性缺血性卒中的溶栓治疗,但其中仅43.3%(29/67)能正确回答溶栓时间窗(<4.5 h);57.7%(251/435)的调查对象可正确识别卒中受累部位为脑;64.4%(280/435)调查对象认为卒中可以预防。卒中相关知识期望获取途径的前3位分别为社区医师指导〔74.0%(322/435)〕、专家讲座〔53.8%(234/435)〕和电视〔38.6%(168/435)〕。单因素分析结果提示不同家庭人均月收入、是否有卒中病史或卒中家族史患者对卒中防治知识的知晓水平比较,差异有统计学意义(P<0.05);多因素分析结果提示文化程度、家庭人均月收入、脑血管病史或卒中家族史及糖尿病病程是调查人群卒中相关知识水平的影响因素(P<0.05)。结论糖尿病人群的卒中防治知识水平不足,尤其是低文化程度、低收入、无脑血管病史、新发糖尿病人群更为明显。社区医师指导的卒中健康教育活动可能是改善糖尿病人群卒中防治知识水平的有效途径。

Background Diabetic patients are at high risk of stroke,and are an important target group for stroke prevention and treatment.Previous research suggests that correct understanding of stroke prevention and treatment can significantly reduce the occurrence of treatment delay and improve the treatment efficiency.However,there are few reports on cognitive characteristics of stroke prevention and treatment knowledge in diabetic patients.Objective To assess the awareness level of stroke prevention and treatment among diabetic patients and analyze the associated factors.Methods This study was performed in Shenzhen Nanshan Hospital between December 2016 and September 2017.A face-to-face questionnaire survey was conducted among 500 diabetic patients hospitalized in Department of Endocrinology,and 435(87.0%) of them responded.The questionnaire designed by our research team includes socio-demographic data,knowledge of stroke prevention and treatment(location of stroke,common risk factors and warning symptoms,emergency treatment,thrombolytic therapy,prevention,and so on),and expected ways to acquire the knowledge.Stepwise multivariate regression analysis was performed to identify key factors possibly related to the awareness level of stroke knowledge.Results This investigation showed that:the awareness rate of stroke risk factors ranged between 5.3% and 80.7%.Among the controllable stroke risk factors,the awareness rate of hypertension was the lowest〔80.7%(351/435)〕,while that of hyperhomocysteinemia was the lowest〔10.3%(45/435)〕.Among the uncontrollable stroke risk factors,the awareness rate of age was the highest〔65.8%(286/435)〕,while that of race was the highest〔5.3%(23/435)〕.The awareness rate of common stroke warning symptoms ranged between 13.1% and 76.8%.Unilateral limb numbness or weakness was known to the largest percent of respondents〔76.8%(334/435)〕,while convulsion was known to the least percent of respondents〔13.1%(57/435)〕.76.6%(333/435) of the respondents reported that they would dial 120 to call an ambulance in case the stroke symptom occurred.15.4%(67/435) of the respondents knew thrombolytic therapy for acute ischemic stroke,but only 43.3%(29/67) of them knew the time window of thrombolytic treatment(within 4.5 hours of stroke onset).57.7%(251/435) of the respondents correctly identified the brain as the organ affected in stroke.64.4%(280/435) of the respondents believed that stroke was preventable.The top three expected ways to acquire stroke knowledge were guidance from the community physician〔74.0%(322/435)〕,expert lectures〔53.8%(234/435)〕,and watching television〔38.6%(168/435)〕.The results of univariate analysis indicated that there was a statistically significant difference in the level of knowledge of stroke prevention among patients with household monthly income per person,personal or familial history of stroke(P<0.05).Multivariate analysis found that education level,household monthly income per person,personal cerebrovascular disease history or familial history of stroke,and duration of diabetes were associated with the awareness level of stroke prevention and treatment knowledge(P<0.05).Conclusion The awareness level of stroke prevention and treatment knowledge among diabetic inpatients was low education level,poor,no personal cerebrovascular disease history or low income subgroup,especially in the newly diagnosed.Stroke education guided by the community doctor may be efficient to improve the stroke knowledge of diabetic inpatients.