常德市缺血性脑卒中危险因素干预依从性及影响因素分析

发布时间：2018-07-28 15:05

【摘要】：目的：通过对常德市多中心卒中登记数据库中患者信息及随访调查数据的分析,了解目前常德市缺血性脑卒中药物治疗现状、停药原因及卒中前后生活方式和遵医服药行为改变情况,并进一步分析影响患者依从性的相关因素,为常德市缺血性脑卒中二级预防的落实提供参考。方法：对符合本次研究条件的常德市卒中登记数据库中的患者的相关信息进行详细记录,并在患者出院1年后进行电话及门诊随访目前服药情况、缺血性脑卒中危险因素是否知晓及家庭年收入,并采用脑卒中行为改变问卷进行调查。将卒中登记数据库中提取的数据及随访调查所得数据建立Access数据库。用SPSS20.0软件包进行数据统计分析缺血性脑卒中常见危险因素干预依从性及其影响因素。结果：1.本次共收集缺血性脑卒中患者1591例,合并有高血压1262例(79.3%),糖尿病646例(40.6%),高血脂1315例(82.7%)。2.患者出院1年后进行随访,合并有高血压的患者坚持服用降压药1097例,依从率86.9%；合并糖尿病的患者坚持服降糖药547例,依从率为84.9%；坚持服用他汀类药物661例,依从率为49.9%。3.出院1年后对服用抗栓药物的随访,继续服用出院时抗栓药物982例,依从率为66.0%(982/1487),其中服用阿司匹林依从率71.6%(575/803)；服用氯吡格雷依从率63.2%(394/623)；服用阿司匹林联合氯吡格雷依从率15.8%(6/38)；服用华法林依从率30.4%(7/23)。4.在患者的所有停药原因中,以患者“自认为病情改善无需服药”为主(23.2%～33.3%)。5.患者的生活方式改变依从性中7个因子的卒中前后对比均为P0.05,遵医服药依从性中的5个因子的卒中前后对比均为P0.05,提示患者的生活方式和遵医服药在缺血性脑卒中后均做出了显著改变。6.影响生活方式改变及遵医服药依从性的多因素分析,HAMD(b=-0.180)、受教育程度(b=0.087)、缺血性脑卒中危险因素是否知晓(b=0.086)及BI指数(b=-0.028)是生活方式改变依从性的主要影响因素(P0.05)；医疗自费(b=-0.127)、缺血性卒中危险因素是否知晓(b=0.191)、受教育程度(b=0.132)及家庭年收入(b=-0.112)是遵医服药依从性的主要影响因素(P0.05)。结论：常德地区缺血性脑卒中患者的药物治疗依从率不佳,但在生活方式改变和遵医服药依从性方面均做出了积极改变。
[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.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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