脑梗死患者二级预防药物依从性与社会因素、卒中后抑郁和卒中程度的研究

Relationship between secondary prevention medications adherence and socialfactors,post stroke depression and stroke degree in patients with cerebral infarction

目的探讨脑梗死患者二级预防药物依从性的现状,以及与社会因素、卒中后抑郁和卒中程度的关系。方法采用方便抽样法,选择该院2017年6月至2020年5月住院的539例脑梗死患者为研究对象。就诊时收集患者一般资料、美国国立卫生研究院卒中量表(NIHSS)评分和Zung抑郁量表评分;随访6个月,497例患者完成随访。采用服药依从问卷量表进行评分,根据评分结果将497例患者分为高依从组、中依从组和低依从组,比较分析脑梗死患者二级预防药物依从性与社会因素、卒中后抑郁和卒中程度等影响因素的相关性。结果中、高依从组年龄≥60岁、受教育时间≤6年、无配偶、居住在农村、月平均收入<3000元、自费医疗、卒中后抑郁、卒中严重程度中型及以上、合并高血压和糖尿病的比例明显低于低依从组;中、高依从组无抑郁和卒中严重程度轻型比例明显高于低依从组,差异有统计学意义(P<0.05)。logistic回归分析结果显示低教育水平≤6年、合并高血压、合并糖尿病、卒中后抑郁、卒中严重程度中型及以上与脑梗死患者二级预防药物依从性低独立相关(P<0.05);且抑郁程度越重,脑梗死患者二级预防药物依从性低发生率越高。结论脑梗死患者二级预防药物依从性低,对脑梗死患者不仅要重视肢体功能康复训练,更要早日进行心理干预,加强患者和家属对卒中二级预防用药重要性、药物疗效及用药注意事项等相关知识的宣教,并定期电话随访,提高脑梗死患者二级预防药物依从性。

Objective To investigate the status quo of secondary prevention medications adherence in the patients with cerebral infarction and its relationship between with socialfactors,post stroke depression and stroke degree.Methods A total of 539 patients with cerebral infarction admitted in this hospital from June 2017 to may 2020 were selected by the convenience sampling method.The general data in visiting,NIHSS score and Zung Depression Scale score were collected.The patients were followed up for six months,and 497 patients completed the follow-up.The scoring was conducted by the medication adherence questionnaire scale.The patients were divided into the high compliance group,middle compliance group and low compliance group according to the medications adherence scoring results.The correlation between the secondary prevention medications adherence in the patients with cerebral infarction with the social factors,post stroke depression and stroke degree was comparatively analyzed.Results The proportions of the patients with the age≥60 years old,education time≤6 years,spouseless,living in rural areas,mean month income<3000 Yuan,medial pay at their own expense,post-stroke depression,moderate and above stroke severity,complicating hypertension and diabetes mellitus in the high compliance group were significantly lower than those in the low compliance group.The proportions of no depression and mild stroke severity in the middle and high compliance groups were significantly higher than those in the low compliance group(P<0.05).the Logistic regression analysis results showed that the low education level≤6 years,complicating hypertension,diabetes mellitus,post-stroke depression,moderate and above stroke severity were independently related with low secondary prevention medications adherence in the patients with cerebral infarction.Moreover the severer the depression degree,the higher the incidence of secondary prevention medications adherence low in the patients with cerebral infarction was(P<0.05).Conclusion The secondary prevention medications adherence is low in the patients with cerebral infarction,for the patients with cerebral infarction,we should not only pay attention to the limb function rehabilitation training,but also carry out the psychological intervention as soon as possible,strengthen the publicity and education of importance of secondary prevention drugs for stroke,drug efficacy and precautions for drugs on the patients and their families,and conduct regular telephone follow-up to improve the secondary prevention medications adherence in the patients with cerebral infarction.