缺血性脑卒中患者应用他汀药物二级预防依从性的影响因素分析

Analysis of factors influencing compliance with secondary prevention of statins in patients with ischemic stroke

目的 探讨缺血性脑卒中他汀药物二级预防依从性影响因素。方法 回顾性分析2019年1月~2021年6月的南通市第三人民医院诊治180例缺血性脑卒中患者的临床资料,采用依从性标准将其分为依从性好130例及依从性差50例,比较不同依从性患者年龄、性别、文化程度、居住地、缺血性脑卒中病程、二级预防认知、医患关系、医疗费用支付方式、经济情况、他汀类不良反应、基础疾病等指标的差异。结果 依从性差组年龄≥75岁、小学以下文化、居住农村、脑卒中病程≥5年、二级预防误、认知错医患关系一般、自费治疗、经济情况较差、药物不良反应、基础疾病≥3种比例高于依从性好组,差异有统计学意义(P <0.05)。多因素Logistic分析影响他汀药物二级预防依从性因素为:年龄≥75岁(OR=5.578,95%CI:1.513~20.567)、二级预防认知错误(OR=5.122,95%CI:1.092~24.054)、经济情况差(OR=4.885,95%CI:1.694~14.092)、医患关系一般(OR=4.606,95%CI:1.287~16.489)。结论 缺血性脑卒中他汀类二级预防依从性较差,影响因素复杂,应实施针对性措施提高依从性。

Objective To investigate the factors influencing compliance with secondary prevention of statins in ischemic stroke. Methods The clinical data of 180 patients with ischemic stroke diagnosed and treated in Nantong Third People’s Hospital from January 2019 to June 2021 were retrospectively analyzed. They were divided into 130 cases with good compliance and 50 cases with poor compliance according to the compliance standard. The differences of age, gender, education level, residence, ischemic stroke course, secondary prevention cognition, doctor-patient relationship, health care payment method, financial situation, adverse statins reactions, underlying diseases and some other indicators were compared among patients with different compliance. Results In the poor compliance group, the proportions of patients aged ≥ 75 years, educated below primary school, living in rural areas, with stroke duration ≥ 5years, with cognitive errors in secondary prevention, with a poor doctor-patient relationship, self-financing treatment, with poor financial situation, and with ≥ 3 underlying diseases were higher than in the good adherence group, with a statistically significant difference(P < 0.05).Factors affecting compliance of secondary prevention of statins were: age ≥ 75 years(OR = 5.578, 95%CI: 1.513 ~ 20.567), cognitive errors in secondary prevention(OR = 5.122, 95%CI: 1.092 ~ 24.054), poor financial situation(OR = 4.885, 95%CI: 1.694 ~ 14.092), fair doctor-patient relationship(OR = 4.606, 95% CI: 1.287 ~ 16.489). Conclusion Factors influencing poor compliance to secondary prevention of statins in ischemic stroke are complex. Targeted measures should be implemented to improve adherence.