冠心病患者PCI术后服用抗血小板药物依从性研究及影响因素分析
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摘要
研究目的
探讨冠心病患者经皮冠状动脉介入术(precutaneous coronary intervention, PCI)术后服用抗血小板药物的依从情况及其影响因素,为临床及社区医疗卫生工作提供有意义的参考。
研究方法
研究对象选取2008年8月-11月期间,在山西省三所三级甲等医院成功实施PCI术的患者。调查问卷包括：一般人口学资料调查表、服药依从性量表和服药依从性影响因素调查表。获得知情同意后,以调查问卷为工具,分别在PCI术后6个月、12个月采取电话随访的方式进行回访,评估患者术后6个月、12个月服用抗血小板药物的依从性及其影响因素,并比较术后6个月及12个月依从性与影响因素有无差别。所得数据采用SPSS11.5软件包进行统计分析,统计分析方法包括：描述性统计分析、一般线性模型分析、配对资料秩和检验和验证性因子分析。
结果
(1)患者PCI术后6个月的完全遵医服药的依从性为39.8%,44.4%的患者表现出较好的依从性。
(2)患者PCI术后12个月的完全遵医服药的依从性为33.9%,54.4%的患者表现出较好的依从性。
(3)一般线性分析结果表明：影响PCI术后6个月的患者服用抗血小板药物依从性的因素为婚姻、职业、月收入、用药知识、用药信念行为以及社会、家庭支持；影响PCI术后12个月的患者服用抗血小板药物依从性的因素为月收入、用药信念行为以及社会、家庭支持。不同职业、月收入患者对服药依从性的影响具有统计学意义。
(4)配对资料秩和检验结果表明：冠心病患者PCI术后6个月与12个月的服药依从性、用药知识的差别有统计学意义。
结论
冠心病患者PCI术后服用抗血小板药物的依从性有待进一步提高。医护人员需针对其不同职业、经济收入、不同时期主要影响因素,制定系统有效的干预措施,定期对出院患者进行多方式的随访,不断丰富用药知识,强化用药信念行为,提高社会、家庭支持,使患者树立战胜疾病的信心。
Objective:The study was aim at investigating the medication compliance of anti-platelet drugs treatment and influencing factors of coronary heart disease who are after precutaneous coronary intervention (PCI), and setting uP seientific basiec data, so as to provide a meaningful reference.
Methods:3 tertiary hospitals in Shanxi province were selected by random sampling.182 subjects, who had done successful PCI from August to November in 2008, were investigated in a manner of telephone interview when obtained informed consent. Topics covered medication compliance schedule and medication compliance affecting factors schedule, and general demographic information questionnaires. Use questionnaire to investigate patients' medication compliance of anti-platelet and its influencing factors, then compiare the differences between compliance and influencing factors after 6 months and 12 months. All data were analyzed with the SPSS 11.5 statistical analysis methods, including descriptive statistics analysis, general linear model analysis, nonparametric test and confirmatory factor analysis, et al. The influencing factors of taking anti-platelet drug compliance which after PCI 6 months and 12 months were analyzed separately by general linear analysis, the difference between compliance and influencing factors after 6 months and 12 months have been analyzed by rank sum test.
Result:(1)6 months after PCI, the rate of fully compliance with prescribed medication was 39.8%, and 44.4% of patients showed good compliance.
(2) 12 months after PCI, the rate of fully compliance with prescribed medication was 33.9%, and 54.4% of patients showed good compliance.
(3) General linear analysis showed that:6 months after PCI, anti-platelet drugs medication compliance in CHD patients was affected by marriage, occupation, monthly income, medication knowledge, medication beliefs, and support of social and family.12 months after PCI, The compliance of anti-platelet drugs medication compliance was affected by monthly income, medication beliefs, and support of social and family.
(4) The Paired rank sum test showed:the differences of medication compliance between 6 months and 12 months after PCI in CHD patients has statistically significance. The same results were obtained on medication knowledge.
Conclusions:The compliance of anti-platelet drugs needs to be further improved. The systematic and effective interventions should be scheduled according to different influencing factors in different periods. Discharged patients should be followed up in many ways, continuing to strengthen knowledge of medication and to improve social and family support, building the confidence of must be healthy.
探讨冠心病患者经皮冠状动脉介入术(precutaneous coronary intervention, PCI)术后服用抗血小板药物的依从情况及其影响因素,为临床及社区医疗卫生工作提供有意义的参考。
研究方法
研究对象选取2008年8月-11月期间,在山西省三所三级甲等医院成功实施PCI术的患者。调查问卷包括：一般人口学资料调查表、服药依从性量表和服药依从性影响因素调查表。获得知情同意后,以调查问卷为工具,分别在PCI术后6个月、12个月采取电话随访的方式进行回访,评估患者术后6个月、12个月服用抗血小板药物的依从性及其影响因素,并比较术后6个月及12个月依从性与影响因素有无差别。所得数据采用SPSS11.5软件包进行统计分析,统计分析方法包括：描述性统计分析、一般线性模型分析、配对资料秩和检验和验证性因子分析。
结果
(1)患者PCI术后6个月的完全遵医服药的依从性为39.8%,44.4%的患者表现出较好的依从性。
(2)患者PCI术后12个月的完全遵医服药的依从性为33.9%,54.4%的患者表现出较好的依从性。
(3)一般线性分析结果表明：影响PCI术后6个月的患者服用抗血小板药物依从性的因素为婚姻、职业、月收入、用药知识、用药信念行为以及社会、家庭支持；影响PCI术后12个月的患者服用抗血小板药物依从性的因素为月收入、用药信念行为以及社会、家庭支持。不同职业、月收入患者对服药依从性的影响具有统计学意义。
(4)配对资料秩和检验结果表明：冠心病患者PCI术后6个月与12个月的服药依从性、用药知识的差别有统计学意义。
结论
冠心病患者PCI术后服用抗血小板药物的依从性有待进一步提高。医护人员需针对其不同职业、经济收入、不同时期主要影响因素,制定系统有效的干预措施,定期对出院患者进行多方式的随访,不断丰富用药知识,强化用药信念行为,提高社会、家庭支持,使患者树立战胜疾病的信心。
Objective:The study was aim at investigating the medication compliance of anti-platelet drugs treatment and influencing factors of coronary heart disease who are after precutaneous coronary intervention (PCI), and setting uP seientific basiec data, so as to provide a meaningful reference.
Methods:3 tertiary hospitals in Shanxi province were selected by random sampling.182 subjects, who had done successful PCI from August to November in 2008, were investigated in a manner of telephone interview when obtained informed consent. Topics covered medication compliance schedule and medication compliance affecting factors schedule, and general demographic information questionnaires. Use questionnaire to investigate patients' medication compliance of anti-platelet and its influencing factors, then compiare the differences between compliance and influencing factors after 6 months and 12 months. All data were analyzed with the SPSS 11.5 statistical analysis methods, including descriptive statistics analysis, general linear model analysis, nonparametric test and confirmatory factor analysis, et al. The influencing factors of taking anti-platelet drug compliance which after PCI 6 months and 12 months were analyzed separately by general linear analysis, the difference between compliance and influencing factors after 6 months and 12 months have been analyzed by rank sum test.
Result:(1)6 months after PCI, the rate of fully compliance with prescribed medication was 39.8%, and 44.4% of patients showed good compliance.
(2) 12 months after PCI, the rate of fully compliance with prescribed medication was 33.9%, and 54.4% of patients showed good compliance.
(3) General linear analysis showed that:6 months after PCI, anti-platelet drugs medication compliance in CHD patients was affected by marriage, occupation, monthly income, medication knowledge, medication beliefs, and support of social and family.12 months after PCI, The compliance of anti-platelet drugs medication compliance was affected by monthly income, medication beliefs, and support of social and family.
(4) The Paired rank sum test showed:the differences of medication compliance between 6 months and 12 months after PCI in CHD patients has statistically significance. The same results were obtained on medication knowledge.
Conclusions:The compliance of anti-platelet drugs needs to be further improved. The systematic and effective interventions should be scheduled according to different influencing factors in different periods. Discharged patients should be followed up in many ways, continuing to strengthen knowledge of medication and to improve social and family support, building the confidence of must be healthy.
引文
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[3]Carin Alm-Roijer, Martin Stagmo, Giggi Ude'n,et al. Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease[J]. European Journal of Cardiovascular Nursing.2004,3:321-330.
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[5]杨祖福.心脏康复及其在我国的发展[J].中国康复理论与实践.2008.14(4)：301-302.
[6]Cannon RO 3rd. Restenosis after angioplasty [J]. N Engl J Med.2002; 346:1182-1183.
[7]梁兆光,周玉杰,陈柯萍.冠状动脉疾病介入诊疗的概念和进展[M].现代心脏疾病介入诊疗基础.人民卫生出版社.2007：45-46.
[8]Higgins, Rosemary O. Expressed preferences for health education of patients after percutaneous coronary intervention. European Journal of Cardiovascular Prevention(C)2005 European Society of Cardiology, Volume 12(6), December 2005:572-579.
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