【摘要】：目的：通過對(duì)常德市多中心卒中登記數(shù)據(jù)庫中患者信息及隨訪調(diào)查數(shù)據(jù)的分析,了解目前常德市缺血性腦卒中藥物治療現(xiàn)狀、停藥原因及卒中前后生活方式和遵醫(yī)服藥行為改變情況,并進(jìn)一步分析影響患者依從性的相關(guān)因素,為常德市缺血性腦卒中二級(jí)預(yù)防的落實(shí)提供參考。 方法：對(duì)符合本次研究條件的常德市卒中登記數(shù)據(jù)庫中的患者的相關(guān)信息進(jìn)行詳細(xì)記錄,并在患者出院1年后進(jìn)行電話及門診隨訪目前服藥情況、缺血性腦卒中危險(xiǎn)因素是否知曉及家庭年收入,并采用腦卒中行為改變問卷進(jìn)行調(diào)查。將卒中登記數(shù)據(jù)庫中提取的數(shù)據(jù)及隨訪調(diào)查所得數(shù)據(jù)建立Access數(shù)據(jù)庫。用SPSS20.0軟件包進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析缺血性腦卒中常見危險(xiǎn)因素干預(yù)依從性及其影響因素。 結(jié)果：1.本次共收集缺血性腦卒中患者1591例,合并有高血壓1262例(79.3%),糖尿病646例(40.6%),高血脂1315例(82.7%)。2.患者出院1年后進(jìn)行隨訪,合并有高血壓的患者堅(jiān)持服用降壓藥1097例,依從率86.9%；合并糖尿病的患者堅(jiān)持服降糖藥547例,依從率為84.9%；堅(jiān)持服用他汀類藥物661例,依從率為49.9%。3.出院1年后對(duì)服用抗栓藥物的隨訪,繼續(xù)服用出院時(shí)抗栓藥物982例,依從率為66.0%(982/1487),其中服用阿司匹林依從率71.6%(575/803)；服用氯吡格雷依從率63.2%(394/623)；服用阿司匹林聯(lián)合氯吡格雷依從率15.8%(6/38)；服用華法林依從率30.4%(7/23)。4.在患者的所有停藥原因中,以患者“自認(rèn)為病情改善無需服藥”為主(23.2%～33.3%)。5.患者的生活方式改變依從性中7個(gè)因子的卒中前后對(duì)比均為P0.05,遵醫(yī)服藥依從性中的5個(gè)因子的卒中前后對(duì)比均為P0.05,提示患者的生活方式和遵醫(yī)服藥在缺血性腦卒中后均做出了顯著改變。6.影響生活方式改變及遵醫(yī)服藥依從性的多因素分析,HAMD(b=-0.180)、受教育程度(b=0.087)、缺血性腦卒中危險(xiǎn)因素是否知曉(b=0.086)及BI指數(shù)(b=-0.028)是生活方式改變依從性的主要影響因素(P0.05)；醫(yī)療自費(fèi)(b=-0.127)、缺血性卒中危險(xiǎn)因素是否知曉(b=0.191)、受教育程度(b=0.132)及家庭年收入(b=-0.112)是遵醫(yī)服藥依從性的主要影響因素(P0.05)。 結(jié)論：常德地區(qū)缺血性腦卒中患者的藥物治療依從率不佳,但在生活方式改變和遵醫(yī)服藥依從性方面均做出了積極改變。
[Abstract]:Objective: to understand the current status of drug therapy for ischemic stroke in Changde city by analyzing the patient information and follow-up data in the multi-center stroke registration database in Changde city. The causes of withdrawal and the changes of lifestyle and compliance with medicine before and after stroke were analyzed and the related factors affecting patients' compliance were analyzed to provide reference for the implementation of secondary prevention of ischemic stroke in Changde city. Methods: the relevant information of patients in Changde stroke registration database was recorded in detail, and the current medication status was followed up by telephone and outpatient one year after discharge from the hospital. Whether the risk factors of ischemic stroke are known and the annual income of the family is known, and the stroke bank is used to change the questionnaire. The data extracted from the stroke registration database and the data obtained from the follow-up survey were used to establish the Access database. The common risk factors of ischemic stroke were statistically analyzed by SPSS20.0 software package. The result is 1: 1. A total of 1591 patients with ischemic stroke were collected, including 1262 (79.3%) patients with hypertension, 646 (40.6%) with diabetes, 1315 (82.7%) with hyperlipidemia. One year after discharge, 1097 patients with hypertension were followed up, the compliance rate was 86.9%; the compliance rate was 84.9% in 547 patients with diabetes mellitus; the compliance rate was 49.9% in 661 patients with statins. One year after discharge, 982 patients were followed up with antithrombotic drugs. The compliance rate was 66.0% (982 / 1487), including 71.6% (575 / 803) for aspirin, 63.2% (394 / 623) for clopidogrel, 15.8% (68.38) for aspirin combined with clopidogrel, 57.5% (57.5 / 803) for clopidogrel, 63.2% (394 / 623) for clopidogrel, 15.8% (68.38) for clopidogrel. Compliance rate with warfarin was 30.4% (7 / 23) .4. Of all the reasons for withdrawal, the main reason was that the patients thought that no medication was needed for the improvement of their condition (23.2or 33.33.3%) .5. The comparison of the seven factors in patients' lifestyle change compliance before and after stroke was P0.05, and the comparison of the five factors in compliance with medicine was P0.05. it was suggested that the patients' lifestyle and compliance with medication in ischemic stroke were all P0.05. Significant changes were made in the middle and later stages. The multivariate analysis of lifestyle changes and compliance with medication was analyzed as follows: Hamd (b-0.180), education level (bP0.087), knowledge of risk factors of ischemic stroke (bN0.086) and BI index (BI-0.028) were the main influencing factors of lifestyle change compliance (P0.05). The main influencing factors of compliance with medicine were medical self-expense (bn), risk factors of ischemic stroke (bn 0.191), education level (bn 0.132) and annual income of family (bn -0.112) (P0.05). Conclusion: the compliance rate of drug therapy in patients with ischemic stroke in Changde area is not good, but positive changes have been made in lifestyle change and compliance with medicine.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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