缺血性卒中患者卒中预防的KAP调查
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摘要
目的：脑血管病的发病率、致残率、死亡率均高,它与心脏病、恶性肿瘤构成了人类的三大致死病因。在我国,缺血性卒中占整个卒中发病率的70-75%,是卒中的主要类型。大量资料表明,对脑血管病危险因素的合理控制可以降低其发病率及复发率。本课题通过对缺血性卒中患者的调查,了解缺血性卒中患者预防的现状及可能的原因,为卒中教育提供参考。
方法：研究对象是2009年10月-2010年2月山西医科大学第一医院神经内科收治的缺血性卒中患者168例。入院当天详细了解患者缺血性卒中的常见可干预危险因素(高血压、糖尿病、血脂异常、吸烟、肥胖)的情况,并详细记录患者的一般资料、疾病的病程、诊治医院、用药过程、控制水平、不用药的原因、疾病与卒中关系的知晓情况。入院后检查患者的相关危险因素。统计方法：采用SPSS13.0软件,定量资料采用均数±标准差,定性资料采用率、构成比。
结果：
1.缺血性卒中患者危险因素的知晓情况：入院前已知的高血压患者占全部高血压患者的88.71%(110／124),入院前已知的糖尿病患者占全部糖尿病患者的59.65%(34／57),入院前已知的血脂异常患者占全部血脂异常患者的12.00%(6／50),肥胖患者占调查人数的12.50%(21／168),吸烟患者占调查人数的38.69%(65／168)。
2.缺血性卒中危险因素的治疗情况：规律服药的高血压患者占63.64%(70／110),规律用药的糖尿病患者占58.82%(20／34),6例血脂异常患者2例规律服药。
3.缺血性卒中危险因素的控制情况：33.64%(37／110)高血压患者监测血压显示控制在正常范围。35.29%(12／34)糖尿病患者糖化血红蛋白达标。
4.缺血性卒中二级预防：规范服用抗血小板药物的患者占既往有缺血性卒中病史患者的30%。
4.高血压、糖尿病、血脂异常、肥胖、吸烟是缺血性卒中的危险因素,患者表示知道的分别占42.73%、52.94%、0%、0%、0%。
结论：
1.缺血性卒中患者的一级预防状况：高血压、糖尿病、吸烟、血脂异常、肥胖等脑血管病的常见危险因素控制情况不佳,其中,高血压的知晓控制情况较好,糖尿病次之,血脂异常差。
2.缺血性卒中患者的二级预防：本调查中规范进行抗血小板治疗的仅占30%。危险因素的控制情况同一级预防。
Objective:The incidence of cerebrovascular disease, disability and mortality are high, with heart disease, cancer constitute the three major causes of death in human. In our country, the ischemic stroke incidence of stroke in 70-75 percent, is the main types of stroke. Large amounts of data indicate that cerebrovascular disease risk factors on the reasonable control can reduce the incidence and recurrence rate.This topic through the investigation of ischemic stroke patients, ischemic stroke patients to prevent the situation and the reasons for stroke, may provide reference for education
Methods:All patients in October 2009-February 2010 Department of Neurology, First Hospital of Shanxi Medical University, admitted 168 patients with ischemic stroke. Learn more about the day of admission in patients with ischemic stroke can interfere with the common risk factors (hypertension, diabetes, dyslipidemia, smoking, obesity) situation, and detailed records of patients with general information, diagnosis and treatment, controllevel, the reasons for not drug use, knowledge of the relationship between disease and stroke cases.After admission examination of the patient associated risk factors.Statistical Methods:SPSS 13.0 software, quantitative data with the use of mean±standard deviation, qualitative data using rate, proportion.
Results:
1.Ischemic stroke risk factors in patients with known conditions:pre-hospital patients with known high blood pressure in hypertensive patients accounted for 88.71%(110/124), known diabetes prior to admission accounted for 59.65% of diabetic patients (34/57), pre-hospital patients with known dyslipidemia dyslipidemia in patients with total 12.00%(6/50), obese patients accounted for 12.50% of those surveyed (21/168), smoking patients accounted for 38.69% of those surveyed (65/168).
2.Risk factors for ischemic stroke treatment:The law of hypertensive patients with medication accounted for 63.64%(70/110), regular medication with diabetes accounted for 58.82%(20/34),6 cases were two cases of dyslipidemia drugs laws. Risk factors for ischemic stroke.
3.To control the situation:33.64%(37/110) to monitor blood pressure in patients with hypertension display control in the normal range. Poor control of glucose condition,12 patients had glycated hemoglobin compliance status of diabetes control rating scale.
4.Secondary prevention of ischemic stroke:specification of patients taking antiplatelet drugs accounted for a history of ischemic stroke patients with a history of 30%.
5.Hypertension, diabetes, dyslipidemia, obesity, smoking is a risk factor of ischemic stroke, patients know that accounted for 42.73%,52.94%,0%,0%,0%.
Conclusion:
1.Primary prevention of ischemic stroke:hypertension, diabetes, smoking, dyslipidemia, obesity and other risk factors for cerebrovascular disease control of the situation is not optimistic.control of blood pressure is better, followed by diabetes, poor blood lipid abnormalities.
2.Secondary prevention of ischemic stroke:the survey specifications antiplatelet therapy only 30%.Control of risk factors for primary prevention with the situation.
方法：研究对象是2009年10月-2010年2月山西医科大学第一医院神经内科收治的缺血性卒中患者168例。入院当天详细了解患者缺血性卒中的常见可干预危险因素(高血压、糖尿病、血脂异常、吸烟、肥胖)的情况,并详细记录患者的一般资料、疾病的病程、诊治医院、用药过程、控制水平、不用药的原因、疾病与卒中关系的知晓情况。入院后检查患者的相关危险因素。统计方法：采用SPSS13.0软件,定量资料采用均数±标准差,定性资料采用率、构成比。
结果：
1.缺血性卒中患者危险因素的知晓情况：入院前已知的高血压患者占全部高血压患者的88.71%(110／124),入院前已知的糖尿病患者占全部糖尿病患者的59.65%(34／57),入院前已知的血脂异常患者占全部血脂异常患者的12.00%(6／50),肥胖患者占调查人数的12.50%(21／168),吸烟患者占调查人数的38.69%(65／168)。
2.缺血性卒中危险因素的治疗情况：规律服药的高血压患者占63.64%(70／110),规律用药的糖尿病患者占58.82%(20／34),6例血脂异常患者2例规律服药。
3.缺血性卒中危险因素的控制情况：33.64%(37／110)高血压患者监测血压显示控制在正常范围。35.29%(12／34)糖尿病患者糖化血红蛋白达标。
4.缺血性卒中二级预防：规范服用抗血小板药物的患者占既往有缺血性卒中病史患者的30%。
4.高血压、糖尿病、血脂异常、肥胖、吸烟是缺血性卒中的危险因素,患者表示知道的分别占42.73%、52.94%、0%、0%、0%。
结论：
1.缺血性卒中患者的一级预防状况：高血压、糖尿病、吸烟、血脂异常、肥胖等脑血管病的常见危险因素控制情况不佳,其中,高血压的知晓控制情况较好,糖尿病次之,血脂异常差。
2.缺血性卒中患者的二级预防：本调查中规范进行抗血小板治疗的仅占30%。危险因素的控制情况同一级预防。
Objective:The incidence of cerebrovascular disease, disability and mortality are high, with heart disease, cancer constitute the three major causes of death in human. In our country, the ischemic stroke incidence of stroke in 70-75 percent, is the main types of stroke. Large amounts of data indicate that cerebrovascular disease risk factors on the reasonable control can reduce the incidence and recurrence rate.This topic through the investigation of ischemic stroke patients, ischemic stroke patients to prevent the situation and the reasons for stroke, may provide reference for education
Methods:All patients in October 2009-February 2010 Department of Neurology, First Hospital of Shanxi Medical University, admitted 168 patients with ischemic stroke. Learn more about the day of admission in patients with ischemic stroke can interfere with the common risk factors (hypertension, diabetes, dyslipidemia, smoking, obesity) situation, and detailed records of patients with general information, diagnosis and treatment, controllevel, the reasons for not drug use, knowledge of the relationship between disease and stroke cases.After admission examination of the patient associated risk factors.Statistical Methods:SPSS 13.0 software, quantitative data with the use of mean±standard deviation, qualitative data using rate, proportion.
Results:
1.Ischemic stroke risk factors in patients with known conditions:pre-hospital patients with known high blood pressure in hypertensive patients accounted for 88.71%(110/124), known diabetes prior to admission accounted for 59.65% of diabetic patients (34/57), pre-hospital patients with known dyslipidemia dyslipidemia in patients with total 12.00%(6/50), obese patients accounted for 12.50% of those surveyed (21/168), smoking patients accounted for 38.69% of those surveyed (65/168).
2.Risk factors for ischemic stroke treatment:The law of hypertensive patients with medication accounted for 63.64%(70/110), regular medication with diabetes accounted for 58.82%(20/34),6 cases were two cases of dyslipidemia drugs laws. Risk factors for ischemic stroke.
3.To control the situation:33.64%(37/110) to monitor blood pressure in patients with hypertension display control in the normal range. Poor control of glucose condition,12 patients had glycated hemoglobin compliance status of diabetes control rating scale.
4.Secondary prevention of ischemic stroke:specification of patients taking antiplatelet drugs accounted for a history of ischemic stroke patients with a history of 30%.
5.Hypertension, diabetes, dyslipidemia, obesity, smoking is a risk factor of ischemic stroke, patients know that accounted for 42.73%,52.94%,0%,0%,0%.
Conclusion:
1.Primary prevention of ischemic stroke:hypertension, diabetes, smoking, dyslipidemia, obesity and other risk factors for cerebrovascular disease control of the situation is not optimistic.control of blood pressure is better, followed by diabetes, poor blood lipid abnormalities.
2.Secondary prevention of ischemic stroke:the survey specifications antiplatelet therapy only 30%.Control of risk factors for primary prevention with the situation.
引文
[1]中国脑血管病防治指南.卫生部疾病控制司,中华医学会神经病学分会.2005.1-2.
[2]wang Y,Nguyen-Huynh MN, Zhou Y, et al. Registry of acute cerebrovascular events(RACE):A national stroke registry in China. Stroke,2009,40:e265.
[3]WolfPA, ClagettGP, Easton JD, et al. Preventingischemic stroke in patients With prior stroke and transient ischemic attack:a statement for healthcare profess Sionals from the Stroke Council of the American Heart Association.Stroke,1999,30(9):1991-1994.
[4]吴桂贤,吴兆苏,曾哲淳,等.北京地区人群脑卒中发病时间模式的研究.中华流行病学杂志,2002,23：277-280.
[5]Holloway RG,Benesch C,Rush SR.Stroke prevention narrowing the evidence-practice gap.Neurology,2000,54(10):1899-1906
[6]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379-382.
[7]Albert KGMM.The diagnosis and typing for diabetes mellitus[J]. Diabetes Voice,1999,44:35.
[8]Rosengren A, Welin L, Tsipogianni A, et al. Impact of cardiocascular risk factors on coronary heart disease and mortality among middle aged diabetic men:a general population study. BMJ,1989,299:1127-1131.
[9]中国成人血脂异常防治指南制订联合会.中国成人血脂异常防治指南.中华心血管病杂志,2007,35：390-419.
[10]陈春明,孔灵芝.主编.中国成人超重与肥胖症预防控制指南.北京：人民卫生出版社,2006.
[11]吴兆苏,崇华,赵冬,等.中国多省市心血管病趋势及决定因素的人群监测(中国MONICA方案)-Ⅰ.发病率和死亡率监测结果.中华心血管病杂志,1997,25：6.
[12]Hilleman DE, Lucas BD Jr.Angiotensin-converting enzyme inhibitors and Stroke riSk: benefit beyond blood pressure reduction? Pharmacotherapy,2004,24(8):1064-1076.
[13]中华人民共和国卫生部.中国居民营养与健康状况[调查报告]2002[M].北京：人民卫生出版社,2005：15-16.
[14]Amanda LA, stratton IM, Neil HAW, et aL Association Of systolic blood pressure with macrovascular complications of type 2 diabetes:prospecctive observational study[J]. Br Med J,2000,321(7258):412-419.
[15]UK Prospective Diabetes Study(UKPDS)Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patient with type 2 diabetes. Lancet,1998,352:837-853.
[16]Adams HP Jr, Adams RJ, Brott T, et al 缺血性卒中患者的早期处理指南：美国 卒中学会卒中委员会科学声明.曲东锋,陈兴洲,李宏建,等,译.国外医学脑血管疾病分册,2003,11：323-339.
[17]Pearson TA, Blair SN, Daniels SR, et al. AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke:2002 Update:Condensus Panel Guide to Comprehensive RiSk Reduction for Adult Patients Without Coronary or other Atherosclerotic Vascular Diseases.American Heart Association Science Advisory and Coordinating Committee.Circulation,2002,16(3):388-391.
[18]Bhatt DL, Kapadia SR, Yadav JS, et al. Update on clinical trials of antiplatelet therapy for cerebrovascular diseases. Cerebrovasc Dis,2000,10(Suppl 5):34-40
[19]吴敌,马锐华.王伊龙,等.缺血性卒中二级预防的药物依从性调查[J].中华内科杂志,2005,44(7)：506-508.
[20]De Schryver EL, Van Gijn J,Kappelle U, et al. Dutch TIA trial and SPIRIT study groups. Non adherence to aspirin or anticoagulants in secondary prevention after ischaemie stroke[J]. J Neurol,2005,52:1316-1321.
[1]吴兆苏,崇华,赵冬,等.中国多省市心血管病趋势及决定因素的人群监测(中国MONICA方案)-Ⅰ.发病率和死亡率监测结果.中华心血管病杂志,1997,25：6.
[2]中国脑血管病防治指南.卫生部疾病控制司,中华医学会神经病学分会.2005.1-2.
[3]Hilleman DE, Lucas BD Jr. Angiotensin-converting enzyme inhibitors and stroke risk: benefit beyond blood pressure reduction? Pharmacotherapy,2004,24:1064-1076.
[4]PROGRESS Collaborative Group. Randomized trial of a perindop rilbased blood-pressure-lowering regimen among 6,105 individuals with p revious stroke or transient ischemic attack. Lancet,2001,358:1033-1041.
[5]DahlofB, Devereux RB, Kjeldsen SE. Cardiovascularmorbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE):a randomised trial against atenolol. Lancet,2002,359:995-1003.
[6]Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention EvaluationStudy Investigators. N Engl J Med,2000,342:145-153.
[7]Progress Collaborative Group. Randomised trial of a perindoprilbased blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet,2001,358:1033-1041.
[8]No authors listed Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillationl Analysis of pooled data from five randomized controlled trials.Arch Intern Med, 1994,154:1449-1457。
[9]No authors listed Secondary prevention in nonrheumatic atrial fibrillation and transient ischaemic attack or minor stroke EAFT (European Atrial Fibrillation Trial) study group.Lancet, 1993,342:1255-1262
[10]Hart RG, Benavente O, McBride R, et al。 Antithrombotic therapy to prevent stroke in patients with atrial fibrillation:A meta-analysis. Ann Intern Med,1999,131:492-501
[11]Albers GW, Dalen JE, Laupacis A, et al. Antithrombotic therapy in atria fibrillation.Chest,2001,119 (Suppl):194S-206S
[12]Sievert H, Lesh MD, Trepels T, et all Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high2risk patients with atrial fibrillation:early clinical experience Circulation,2002,105:1887-1889
[13]UK Prospective Diabetes Study(UKPDS)Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patient with type 2 diabetes. Lancet,1998,352:837-853.
[14]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 华心血管杂志,2007,35(5)：390-419.
[15]Randomized trial of endarterectomy for recently symp tomatic carotid stenosis:final results of the MRC European Carotid Surgery Trial (ECST). Lancet,1998,351:1379-1387.
[16]Brott TG, Brown RD Jr, Meyer FB, et al. Carotid revascularization for prevention of stroke:carotid endarterectomy and carotid artery stenting. Mayo Clin Proc,2004,79:1197 1208.
[17]Furlan AJ, Katzan IL, Caplan LR. Thrombolytic therapy in acute ischemic stroke. Curr Treat Options Cardiovasc Med,2003,5:171-180.
[18]Halkes PH, van Gijn J, Kappelle LJ, et al. for SPR IT Study Group. Asp irin p lus dipyridamole versus asp irin alone after cerebral ischaemia of arterial origin (ESPR IT) randomised controlled trial[J]. Lancet,2006,367:1665-1673.
[19]Bhatt DL, Fox KA, HackeW, et al. for CHAR ISMA Investigators. Clop idogrel and asp irin versus asp irin alone for the p revention of atherothrombotic events [J]. Nengl. J Med,2006, 354:1706-1717.
[20]Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke:A statement for healthcare professionals from the Stroke Council of the American Heart Association.Stroke,2001,32(1):280-299.
[2]wang Y,Nguyen-Huynh MN, Zhou Y, et al. Registry of acute cerebrovascular events(RACE):A national stroke registry in China. Stroke,2009,40:e265.
[3]WolfPA, ClagettGP, Easton JD, et al. Preventingischemic stroke in patients With prior stroke and transient ischemic attack:a statement for healthcare profess Sionals from the Stroke Council of the American Heart Association.Stroke,1999,30(9):1991-1994.
[4]吴桂贤,吴兆苏,曾哲淳,等.北京地区人群脑卒中发病时间模式的研究.中华流行病学杂志,2002,23：277-280.
[5]Holloway RG,Benesch C,Rush SR.Stroke prevention narrowing the evidence-practice gap.Neurology,2000,54(10):1899-1906
[6]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379-382.
[7]Albert KGMM.The diagnosis and typing for diabetes mellitus[J]. Diabetes Voice,1999,44:35.
[8]Rosengren A, Welin L, Tsipogianni A, et al. Impact of cardiocascular risk factors on coronary heart disease and mortality among middle aged diabetic men:a general population study. BMJ,1989,299:1127-1131.
[9]中国成人血脂异常防治指南制订联合会.中国成人血脂异常防治指南.中华心血管病杂志,2007,35：390-419.
[10]陈春明,孔灵芝.主编.中国成人超重与肥胖症预防控制指南.北京：人民卫生出版社,2006.
[11]吴兆苏,崇华,赵冬,等.中国多省市心血管病趋势及决定因素的人群监测(中国MONICA方案)-Ⅰ.发病率和死亡率监测结果.中华心血管病杂志,1997,25：6.
[12]Hilleman DE, Lucas BD Jr.Angiotensin-converting enzyme inhibitors and Stroke riSk: benefit beyond blood pressure reduction? Pharmacotherapy,2004,24(8):1064-1076.
[13]中华人民共和国卫生部.中国居民营养与健康状况[调查报告]2002[M].北京：人民卫生出版社,2005：15-16.
[14]Amanda LA, stratton IM, Neil HAW, et aL Association Of systolic blood pressure with macrovascular complications of type 2 diabetes:prospecctive observational study[J]. Br Med J,2000,321(7258):412-419.
[15]UK Prospective Diabetes Study(UKPDS)Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patient with type 2 diabetes. Lancet,1998,352:837-853.
[16]Adams HP Jr, Adams RJ, Brott T, et al 缺血性卒中患者的早期处理指南：美国 卒中学会卒中委员会科学声明.曲东锋,陈兴洲,李宏建,等,译.国外医学脑血管疾病分册,2003,11：323-339.
[17]Pearson TA, Blair SN, Daniels SR, et al. AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke:2002 Update:Condensus Panel Guide to Comprehensive RiSk Reduction for Adult Patients Without Coronary or other Atherosclerotic Vascular Diseases.American Heart Association Science Advisory and Coordinating Committee.Circulation,2002,16(3):388-391.
[18]Bhatt DL, Kapadia SR, Yadav JS, et al. Update on clinical trials of antiplatelet therapy for cerebrovascular diseases. Cerebrovasc Dis,2000,10(Suppl 5):34-40
[19]吴敌,马锐华.王伊龙,等.缺血性卒中二级预防的药物依从性调查[J].中华内科杂志,2005,44(7)：506-508.
[20]De Schryver EL, Van Gijn J,Kappelle U, et al. Dutch TIA trial and SPIRIT study groups. Non adherence to aspirin or anticoagulants in secondary prevention after ischaemie stroke[J]. J Neurol,2005,52:1316-1321.
[1]吴兆苏,崇华,赵冬,等.中国多省市心血管病趋势及决定因素的人群监测(中国MONICA方案)-Ⅰ.发病率和死亡率监测结果.中华心血管病杂志,1997,25：6.
[2]中国脑血管病防治指南.卫生部疾病控制司,中华医学会神经病学分会.2005.1-2.
[3]Hilleman DE, Lucas BD Jr. Angiotensin-converting enzyme inhibitors and stroke risk: benefit beyond blood pressure reduction? Pharmacotherapy,2004,24:1064-1076.
[4]PROGRESS Collaborative Group. Randomized trial of a perindop rilbased blood-pressure-lowering regimen among 6,105 individuals with p revious stroke or transient ischemic attack. Lancet,2001,358:1033-1041.
[5]DahlofB, Devereux RB, Kjeldsen SE. Cardiovascularmorbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE):a randomised trial against atenolol. Lancet,2002,359:995-1003.
[6]Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention EvaluationStudy Investigators. N Engl J Med,2000,342:145-153.
[7]Progress Collaborative Group. Randomised trial of a perindoprilbased blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet,2001,358:1033-1041.
[8]No authors listed Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillationl Analysis of pooled data from five randomized controlled trials.Arch Intern Med, 1994,154:1449-1457。
[9]No authors listed Secondary prevention in nonrheumatic atrial fibrillation and transient ischaemic attack or minor stroke EAFT (European Atrial Fibrillation Trial) study group.Lancet, 1993,342:1255-1262
[10]Hart RG, Benavente O, McBride R, et al。 Antithrombotic therapy to prevent stroke in patients with atrial fibrillation:A meta-analysis. Ann Intern Med,1999,131:492-501
[11]Albers GW, Dalen JE, Laupacis A, et al. Antithrombotic therapy in atria fibrillation.Chest,2001,119 (Suppl):194S-206S
[12]Sievert H, Lesh MD, Trepels T, et all Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high2risk patients with atrial fibrillation:early clinical experience Circulation,2002,105:1887-1889
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