缺血性脑卒中后二级预防药物依从性现状及对预后的影响
李文健;潘旭东;王静;崔光利;马爱军
【期刊名称】《中华神经科杂志》 【年(卷),期】2017(050)003
【摘要】Objective To investigate the status of medication adherence of secondary prevention after acute ischemic stroke and influence on prognosis in Qingdao area , including antithrombotic drugs , lipid-lowering drugs , antihypertensive drugs and glucose-lowering drugs , to provide the basis for making medical policy.Methods We examined patients with acute cerebral infarction and transient ischemic attack in the Department of Neurology of Affiliated Hospital of Qingdao University from December 2014 to January 2016.Patients′medication status and recurrence of stroke events were registered by using telephone and clinic follow-up within six months after the patients discharged from hospital .The standard of good and bad drug adherence was as follows:good adherence was defined as proportion of days covered ( PDC) ≥80%, bad adherence was defined as PDC <80%.SPSS 19.0 statistical software was used to analyze the influence factors of medication adherence and the influence of medication adherence on prognosis .Results Finally, 444 cases (88.62%) were analyzed.A total of 352 cases (79.28%) had high medication adherence at six months after discharging from hospital .The following factors can
improve the adherence of drug treatment:history of diabetes (108 cases (30.68%) in good medication adherence group , 16 cases (17.39%) in poor medication adherence group,χ2 =6.401, P=0.011), having employee health insurance (186 cases (52.84%) in good medication adherence group , 33 cases (35.87%) in poor medication adherence group ,χ2 =8.405, P=0.004), endovascular stent implantation (29 cases(8.24%) in good medication adherence group, 0 case in poor medication adherence group ,χ2 =8.109, P=0.004), staying in hospital more than 10 days ( 230 cases ( 65.34%) in good medication adherence group , 49 cases ( 53.26%) in poor medication adherence group ,χ2 =4.558, P=0.033).Six months later , the modified Rankin Scale ( mRS) score of poor medication adherence group was significantly higher than that in good adherence group ( mRS score≥3,50 cases (14.20%) in good medication adherence group , 22 cases (23.91%) in poor medication adherence group,χ2 =5.060, P=0.024) .After six months, a total of 13 cases had recurrent cerebral infarction, with two cases ( 0.57%) in good adherence group , 11 cases ( 11.96%) in poor adherence group.High medication adherence was an independent protective factor of recurrent stroke ( OR=0.042, 95%CI 0.008 -0.210, P<0.01 ) .At one, three, six months after discharging from hospital , the medication adherence of antihypertensive and glucose-lowering drugs was better than that of antiplatelet agents and lipid-lowering drugs (all P<0.05).Conclusions
The persistence and adherence to secondary preventive medication in ischemic stroke patients was generally well at 6th month after discharging from hospital.History of diabetes , having employee health insurance , stent implantation and longer hospital stay are the influencing factors to high medication adherence .High medication adherence is an independent protective factor for ischemic stroke recurrence .The medication adherence of antihypertensive and glucose-lowering drugs is better than that of antithrombotic drugs and lipid-lowering drugs.%目的 调查中国青岛地区缺血性脑卒中后患者的药物依从性现状及其对预后的影响,调查药物包括抗栓药物、调脂药物、降压药物和降糖药物,为制定相应的临床措施提供依据.方法回顾性纳入2014年12月至2016年1月于青岛大学附属医院神经内科住院的急性脑梗死或短暂性脑缺血发作患者,通过门诊及电话随访,对入选患者出院后6个月内的服药情况和脑卒中复发的不良事件进行登记.判定患者药物依从性好与差的标准为:遵医嘱服药天数≥总随访天数的80%为药物依从性好;<80%的为药物依从性差.采用SPSS 19.0统计学软件对影响药物依从性的因素及患者药物依从性对预后的影响进行统计分析.结果共有444例(88.62%)缺血性脑卒中患者完成6个月的随访研究.出院后6个月时药物依从性好的患者有352例(79.28%).以下因素能够提高患者的药物依从性:有糖尿病史[依从性好组108例(30.68%),依从性差组16例(17.39%),χ2=6.401,P=0.011]、有职工医保[依从性好组186例(52.84%),依从性差组33例(35.87%),χ2=8.405,P=0.004]、有血管内支架置入史[依从性好组29例(8.24%),依从性差组0例,χ2=8.109,P=0.004]、住院天数大于10 d[依从
缺血性脑卒中后二级预防药物依从性现状及对预后的影响
