脑梗死二级预防患者阿托伐他汀依从性降低的危险因素分析
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摘要
目的探讨脑梗死二级预防患者阿托伐他汀依从性降低的危险因素。方法选择急性脑梗死患者546例随访3个月。依据阿托伐他汀依从性分为依从性降低组和依从性未降低组,比较2组性别,年龄,神经功能评分,药物不同日用量例数,经济问题、中药替代、指导异常、遗忘误解、不良反应、缺乏信心发生率。分析脑梗死二级预防患者阿托伐他汀依从性降低的危险因素。结果调查结束时,21例患者失访,实际完成研究525例,其中患者阿托伐他汀依从性降低281例(53.5%)。依从性降低组与依从性未降低组性别、年龄、NIHSS评分、mRs评分和阿托伐他汀日用量差异无统计学意义(P>0.05);依从性降低组经济问题、中药替代、指导异常、遗忘误解、不良反应、缺乏信心发生率明显高于依从性未降低组,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,经济问题、中药替代、指导异常、遗忘误解、不良反应、缺乏信心是阿托伐他汀依从性降低的危险因素。结论针对上述主观原因采取行之有效的措施,可减少甚至消除脑梗死二级预防期间阿托伐他汀依从性降低。
Objective To investigate the risk factors about reduced atorvastatin compliance in patients with cerebral infarction secondary prevention.Methods The 546 patients with acute cerebral infarction were followed up for 3 months.All patients were divided into two groups according to the decrease of atorvastatin compliance or not.The following factors were compared between the two groups,including sex,age,neurological function,the number of patients with different daily doses of atorvastatin and incidence of following subjective causes,included economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence.Risk factors of reduced compliance of atorvastatin in patients with secondary prevention of cerebral infarction were analyzed.Results At the end of the investigation,21 patients lost their visits and 525 patients completed the study,among which 281 patients(53.5%)had decrease of atorvastatin compliance.There was no significant difference on sex,age,neurological function and the number of patients with different daily doses of atorvastatin between two groups(P>0.05).The incidence of economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence in the decrease of atorvastatin compliance group were significantly higher than those in the not decrease of atorvastatin compliance group(P<0.05).Economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence were the risk factors about reduced atorvastatin compliance by multivariate Logistic regression analysis.Conclusion Taking effective measures against the above subjective causes may reduce or even eliminate the decrease of atorvastatin compliance during the secondary prevention of cerebral infarction.
Objective To investigate the risk factors about reduced atorvastatin compliance in patients with cerebral infarction secondary prevention.Methods The 546 patients with acute cerebral infarction were followed up for 3 months.All patients were divided into two groups according to the decrease of atorvastatin compliance or not.The following factors were compared between the two groups,including sex,age,neurological function,the number of patients with different daily doses of atorvastatin and incidence of following subjective causes,included economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence.Risk factors of reduced compliance of atorvastatin in patients with secondary prevention of cerebral infarction were analyzed.Results At the end of the investigation,21 patients lost their visits and 525 patients completed the study,among which 281 patients(53.5%)had decrease of atorvastatin compliance.There was no significant difference on sex,age,neurological function and the number of patients with different daily doses of atorvastatin between two groups(P>0.05).The incidence of economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence in the decrease of atorvastatin compliance group were significantly higher than those in the not decrease of atorvastatin compliance group(P<0.05).Economic problems,substitution of traditional Chinese medicine,abnormal guidance,forgetting and misunderstandings,adverse reactions and lack of confidence were the risk factors about reduced atorvastatin compliance by multivariate Logistic regression analysis.Conclusion Taking effective measures against the above subjective causes may reduce or even eliminate the decrease of atorvastatin compliance during the secondary prevention of cerebral infarction.
引文
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[5] 中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390-419.
[6] 钟新龙,黄志煌.脑梗死二级预防依从性及再复发的调查[J].现代临床医学,2016,42(1):70-71.
[7] 程阅凤,林丽,董慧,等.脑梗死患者复发的影响因素分析[J].医学综述,2017,23(21):4352-4355.
[8] 谷黎丽,田勇武,贺丹.不同TOAST分型急性脑梗死患者血清hs-CRP和LDL水平变化及临床意义[J].河北医科大学学报,2017,38(5):514-519,524.
[9] 赵培,陶金,袁晓晨,等.冠心病患者PCI术后长期高剂量阿托伐他汀治疗的疗效及安全性[J].临床心血管病杂志,2017,33(3):226-230.
[10] 李頔,魏来,匡扶,等.阿托伐他汀和氟伐他汀调节血脂异常临床效果的Meta分析[J].重庆医学,2017,46(29):4096-4100.
[11] 陶蕾,纪立伟,王艳春.他汀类药物对动脉粥样硬化的疗效研究[J].中国现代医学杂志,2017,27(14):93-98.
[12] 马勋龙,刘洋贝,杨秋,等.阿托伐他汀对老年脑梗死患者颈动脉粥样硬化斑块的影响[J].中国老年学杂志,2017,37(19):4774-4775.
[13] 李荣华,韦世友,管萍,等.氯吡格雷联合阿托伐他汀或瑞舒伐他汀用于脑梗死二级预防效果比较[J].山东医药,2017,57(12):83-85.
[14] 余科,张志新,韩玉乐,等.不同剂量阿托伐他汀对急性脑梗死合并大脑中动脉狭窄患者预后的影响[J].中风与神经疾病杂志,2017,34(3):268-270.
[15] 陈宇丹,胡文立,张娟,等.脑梗死二级预防药物及行为修正的依从性现状分析[J].中国实用神经疾病杂志,2015,18(11):69-70.
[16] 张艳影,石振东.停用阿托伐他汀对老年急性脑梗死患者颈动脉易损斑块及预后的影响研究[J].中国全科医学,2017,20(28):3509-3514.
[17] 黄立宏,冯小芳,黄流清,等.脑梗死二级预防中他汀类药物的应用情况及中断他汀类药物治疗对预后和复发的影响[J].中国老年学杂志,2017,37(3):631-633.
[18] 范军.缺血性脑卒中患者二级预防用药的依从性[J].中国实用神经疾病杂志,2015,18(7):71-72.
[19] 王清华,张庆军,李云霞,等.轻型卒中90d预后及与药物依从性的关系分析[J].中国卒中杂志,2016,11(6):438-442.
[20] 袁晶,朱以诚,姚明,等.急性卒中患者中药服用情况横断面调查[J].中华神经科杂志,2015,48(4):284-287.
[21] 刘存富,王建明.某院脑梗死患者二级预防服药依从性及用药现状调查[J].中国药业,2015,24(19):70-71.
[2] 中华医学会神经病学分会中华医学会神经病学分会.脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273.
[3] 程越朋,孙书军,杨光,等.影响急性脑梗死患者二级预防用药依从性的调查研究[J].卒中与神经疾病,2017,24(1):30-33.
[4] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5] 中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390-419.
[6] 钟新龙,黄志煌.脑梗死二级预防依从性及再复发的调查[J].现代临床医学,2016,42(1):70-71.
[7] 程阅凤,林丽,董慧,等.脑梗死患者复发的影响因素分析[J].医学综述,2017,23(21):4352-4355.
[8] 谷黎丽,田勇武,贺丹.不同TOAST分型急性脑梗死患者血清hs-CRP和LDL水平变化及临床意义[J].河北医科大学学报,2017,38(5):514-519,524.
[9] 赵培,陶金,袁晓晨,等.冠心病患者PCI术后长期高剂量阿托伐他汀治疗的疗效及安全性[J].临床心血管病杂志,2017,33(3):226-230.
[10] 李頔,魏来,匡扶,等.阿托伐他汀和氟伐他汀调节血脂异常临床效果的Meta分析[J].重庆医学,2017,46(29):4096-4100.
[11] 陶蕾,纪立伟,王艳春.他汀类药物对动脉粥样硬化的疗效研究[J].中国现代医学杂志,2017,27(14):93-98.
[12] 马勋龙,刘洋贝,杨秋,等.阿托伐他汀对老年脑梗死患者颈动脉粥样硬化斑块的影响[J].中国老年学杂志,2017,37(19):4774-4775.
[13] 李荣华,韦世友,管萍,等.氯吡格雷联合阿托伐他汀或瑞舒伐他汀用于脑梗死二级预防效果比较[J].山东医药,2017,57(12):83-85.
[14] 余科,张志新,韩玉乐,等.不同剂量阿托伐他汀对急性脑梗死合并大脑中动脉狭窄患者预后的影响[J].中风与神经疾病杂志,2017,34(3):268-270.
[15] 陈宇丹,胡文立,张娟,等.脑梗死二级预防药物及行为修正的依从性现状分析[J].中国实用神经疾病杂志,2015,18(11):69-70.
[16] 张艳影,石振东.停用阿托伐他汀对老年急性脑梗死患者颈动脉易损斑块及预后的影响研究[J].中国全科医学,2017,20(28):3509-3514.
[17] 黄立宏,冯小芳,黄流清,等.脑梗死二级预防中他汀类药物的应用情况及中断他汀类药物治疗对预后和复发的影响[J].中国老年学杂志,2017,37(3):631-633.
[18] 范军.缺血性脑卒中患者二级预防用药的依从性[J].中国实用神经疾病杂志,2015,18(7):71-72.
[19] 王清华,张庆军,李云霞,等.轻型卒中90d预后及与药物依从性的关系分析[J].中国卒中杂志,2016,11(6):438-442.
[20] 袁晶,朱以诚,姚明,等.急性卒中患者中药服用情况横断面调查[J].中华神经科杂志,2015,48(4):284-287.
[21] 刘存富,王建明.某院脑梗死患者二级预防服药依从性及用药现状调查[J].中国药业,2015,24(19):70-71.