本文關(guān)鍵詞：山西省城市神經(jīng)科門診缺血性卒中二級(jí)預(yù)防狀況隨訪分析　出處：《山西醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： ROOTS項(xiàng)目 缺血性卒中 二級(jí)預(yù)防 隨訪

【摘要】：目的:評(píng)估我省2010年參加ROOTS項(xiàng)目缺血性卒中患者5年間二級(jí)預(yù)防執(zhí)行情況。方法:門診收集2010年7月~2010年12月于我省東、西、南、北及中部五所三甲醫(yī)院(山西醫(yī)科大學(xué)第一醫(yī)院、長(zhǎng)治市和平醫(yī)院、大同市第三人民醫(yī)院、汾陽(yáng)市醫(yī)院及陽(yáng)煤集團(tuán)總院)神經(jīng)科門診參加ROOTS項(xiàng)目的缺血性卒中患者資料,收集其5年間一般信息、藥物使用情況、病情變化、危險(xiǎn)因素控制及終點(diǎn)事件等,通過橫斷面調(diào)查及回顧性隊(duì)列研究,利用X2檢驗(yàn)、多因素logistic回歸分析等統(tǒng)計(jì)學(xué)方法,評(píng)估神經(jīng)科門診缺血性卒中患者二級(jí)預(yù)防情況。結(jié)果:橫斷面調(diào)查共收集IS患者292例,5年后隨訪結(jié)果為:死亡13例,被拒絕7例,聯(lián)系方式更改5例,共失訪25例(失訪率8.68%),完成隨訪患者共267例,其中176例男性,91例女性,平均年齡(64.39±11.21)歲,改良Rankin量表(mRS評(píng)分)(1.26±1.21)分。最終38例復(fù)發(fā)心腦血管疾病,其中33例復(fù)發(fā)IS,4例心絞痛或心肌梗死,1例腦出血,預(yù)后不良者(mRS評(píng)分≥3分)有34例,占12.73%�？寡“�、他汀類藥物的使用率隨著時(shí)間的推移呈明顯下降趨勢(shì),由5年前85.62%、31.51%,減少為68.91%、21.72%,與橫斷面調(diào)查結(jié)果對(duì)照,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。降壓藥的使用率由5年前80.48%增加至88.89%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪前后抗血小板、他汀藥物的主要停用原因存在明顯差異,“醫(yī)生未建議”、“病情好轉(zhuǎn)自行停用”為5年后主要停藥原因,行多因素logistic回歸分析發(fā)現(xiàn),合并高血壓病、堅(jiān)持復(fù)診分別為此兩類藥物使用的促進(jìn)因素(P0.05)。我省門診IS患者合并心房顫動(dòng)、心肌梗死等心臟疾病者有36例(12.32%),但使用華法林抗凝者僅6例,隨訪時(shí)減少為2例,且僅1例監(jiān)測(cè)INR比值。其他危險(xiǎn)因素如吸煙、BMI指數(shù)控制等,隨訪后結(jié)果明顯優(yōu)于5年前,但仍有近半數(shù)患者存在定期輸液的情況。IS復(fù)發(fā)病例組與非復(fù)發(fā)病例組在他汀類藥物的使用及堅(jiān)持復(fù)診存在明顯差異(P0.05),定期輸液并不能有效減少IS的復(fù)發(fā)。結(jié)論:盡管我省IS患者合并高血壓病、糖尿病等疾病的比例并無(wú)明顯增加,且該部分人群血壓、血糖控制較前有明顯好轉(zhuǎn),戒煙及BMI指數(shù)正常者較橫斷面調(diào)查時(shí)明顯增加,說(shuō)明前期IS二級(jí)預(yù)防宣教工作已取得初步成效,但抗血小板、他汀類藥物的使用率仍隨時(shí)間呈減少趨勢(shì),仍有部分患者對(duì)輸液治療有所期待,且未養(yǎng)成規(guī)律復(fù)診良好習(xí)慣的現(xiàn)象,提示我省神經(jīng)科門診IS二級(jí)預(yù)防的執(zhí)行情況仍有所欠缺,與指南要求存在一定差距,IS二級(jí)預(yù)防的工作仍任重而道遠(yuǎn)。
[Abstract]:Objective: to evaluate the implementation of secondary prevention in patients with ischemic stroke who participated in ROOTS project in 2010. Methods: from July 2010 to December 2010, outpatients were collected from east and west of our province. The first Hospital of Shanxi Medical University, the Peace Hospital of Changzhi City and the third people's Hospital of Datong City. The data of ischemic stroke patients participating in the ROOTS project in the neurology department of Fenyang Hospital and General Hospital of Yangmei Group were collected for 5 years, including general information, drug use and disease change. Control of risk factors and endpoint events were analyzed by cross-sectional survey and retrospective cohort study, using X2 test, multivariate logistic regression analysis and other statistical methods. Results: 292 patients with is were collected in a cross-sectional survey. The results of follow-up for 5 years were as follows: 13 cases died and 7 cases were rejected. There were 5 cases of change of contact method and 25 cases of missing visit (the rate of missing visit was 8.68%). 267 cases were followed up, of which 176 cases were male and 91 cases were female. The mean age was 64.39 鹵11.21 years old. The modified Rankin scale and Mrs score were 1.26 鹵1.21. Finally, 38 cases of recurrent cardio-cerebrovascular diseases were found. Among them, 34 cases (12.73%) had recurrent angina pectoris or myocardial infarction, 1 case had cerebral hemorrhage, and 34 cases (12.73%) had poor prognosis (mRS score 鈮，

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