山西省城市神经科门诊缺血性卒中二级预防状况随访分析

发布时间：2018-01-17 22:30

  本文关键词：山西省城市神经科门诊缺血性卒中二级预防状况随访分析　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： ROOTS项目 缺血性卒中 二级预防 随访

【摘要】：目的:评估我省2010年参加ROOTS项目缺血性卒中患者5年间二级预防执行情况。方法:门诊收集2010年7月~2010年12月于我省东、西、南、北及中部五所三甲医院(山西医科大学第一医院、长治市和平医院、大同市第三人民医院、汾阳市医院及阳煤集团总院)神经科门诊参加ROOTS项目的缺血性卒中患者资料,收集其5年间一般信息、药物使用情况、病情变化、危险因素控制及终点事件等,通过横断面调查及回顾性队列研究,利用X2检验、多因素logistic回归分析等统计学方法,评估神经科门诊缺血性卒中患者二级预防情况。结果:横断面调查共收集IS患者292例,5年后随访结果为:死亡13例,被拒绝7例,联系方式更改5例,共失访25例(失访率8.68%),完成随访患者共267例,其中176例男性,91例女性,平均年龄(64.39±11.21)岁,改良Rankin量表(mRS评分)(1.26±1.21)分。最终38例复发心脑血管疾病,其中33例复发IS,4例心绞痛或心肌梗死,1例脑出血,预后不良者(mRS评分≥3分)有34例,占12.73%。抗血小板、他汀类药物的使用率随着时间的推移呈明显下降趋势,由5年前85.62%、31.51%,减少为68.91%、21.72%,与横断面调查结果对照,差异有统计学意义(P0.05)。降压药的使用率由5年前80.48%增加至88.89%,差异有统计学意义(P0.05)。随访前后抗血小板、他汀药物的主要停用原因存在明显差异,“医生未建议”、“病情好转自行停用”为5年后主要停药原因,行多因素logistic回归分析发现,合并高血压病、坚持复诊分别为此两类药物使用的促进因素(P0.05)。我省门诊IS患者合并心房颤动、心肌梗死等心脏疾病者有36例(12.32%),但使用华法林抗凝者仅6例,随访时减少为2例,且仅1例监测INR比值。其他危险因素如吸烟、BMI指数控制等,随访后结果明显优于5年前,但仍有近半数患者存在定期输液的情况。IS复发病例组与非复发病例组在他汀类药物的使用及坚持复诊存在明显差异(P0.05),定期输液并不能有效减少IS的复发。结论:尽管我省IS患者合并高血压病、糖尿病等疾病的比例并无明显增加,且该部分人群血压、血糖控制较前有明显好转,戒烟及BMI指数正常者较横断面调查时明显增加,说明前期IS二级预防宣教工作已取得初步成效,但抗血小板、他汀类药物的使用率仍随时间呈减少趋势,仍有部分患者对输液治疗有所期待,且未养成规律复诊良好习惯的现象,提示我省神经科门诊IS二级预防的执行情况仍有所欠缺,与指南要求存在一定差距,IS二级预防的工作仍任重而道远。
[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 卤11.21 years old. The modified Rankin scale and Mrs score were 1.26 卤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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