影响和提高缺血脑卒中二级预防依从性的研究.pdfVIP

影响和提高缺血性脑卒中二级预防依从性的研究 摘 要 背景：卒中二级预防的实践与指南的要求间存在巨大的差距，产生 这种差距的原因十分复杂，如何提高实践对指南的依从性，目前还缺乏 十分有效的方法。 目的：第一探讨影响缺血性卒中用药依从性的因素。第二通过医师 培训和专病门诊，缩小临床实践与缺血性卒中二级预防指南间的差距。 方法：选择在脑卒中专病门诊就诊的 305 例缺血性卒中患者，分析 产生影响卒中二级预防实践与指南要求差距的原因。比较患者在不同时 期出院（医师规范培训前和培训后）及在专病门诊随访期间使用抗栓药、 他汀类药物、不规范用药和降压药的情况。 结果：日常生活能力量表（Barthel Index, BI ）评分高、有高脂血症 史、教育程度高、有高血压家族史、年轻、血管性共病多、简易智能状 态检查（mini-mental state examination, MMSE ）评分高的患者较易遵循指 南的治疗要求。在医师规范培训后，患者出院用药中，抗栓药（79.3%对 93.1%，p0.001 ）和他汀类药（19.5%对59.2%，p0.001 ）的使用率显著 提高，不合指南要求的不规范用药（47.1%对 27.5% ，p=0.001 ）显著降 低。高血压的治疗率（88.4%对94.0% ）没有差异。与出院时相比，在专 病门诊随访的患者的抗栓药和他汀类药使用率得到进一步提高，不规范 用药进一步降低。出院带药规范者随访期的用药依从性高。 结论：年龄、教育程度、认知功能、血管性共病多少、日常生活能 力影响患者对卒中二级预防的用药依从性。医师培训能提高缺血性卒中 二级预防处方的规范性，专病门诊能进一步提高患者的依从性，出院带 药影响随访期用药的依从性。 关键词 缺血性脑卒中，二级预防，治疗指南，依从性，相关因素 INFLUENTIAL FACTORS AND MEANS TO IMPROVE THE COMPLIANCE WITH THE GUIDELINE FOR SECONDARY PREVENTION OF ISCHEMIC STROKE ABSTRACT Background: The cause of the gap between clinical practice and the guideline for secondary prevention of ischemic stroke were complex, there were still no effective mean to narrow the gap. Objective: First to detect the influential factors of compliance. Second, the effects of physician training program and stroke clinic for narrowing the gap between clinical practice and the guideline for secondary prevention of ischemic stroke were tested. Methods: 305 patients with ischemic stroke were enrolled in the stroke clinic. The influential factors of compliance were analyzed. Patients’ usage of antithrombotic agents, statins, unproved therapies, and antihypertensive agents at time of discharge and follow-up period were compared between pre- and post- physician training program groups. Result: The patients with high Barthe