冯建玉

摘 要 目的：了解社区缺血性脑血管病患者的抗血小板药物的应用情况，为提高缺血性脑血管病二级预防效果提供依据。方法：收集本社区登记在册的缺血性脑卒中患者286例和短暂性脑缺血发作（TIA）患者36例，分析患者出院时以及出院后6个月时使用抗血小板药物种类和剂量，以及患者未服用抗血小板药物的原因。结果：出院时，有305例患者在使用抗血小板药物，其中275例为缺血性脑卒中患者，服药率为96.2%（275/286）；30例为TIA患者，使用率为83.3%（30/36），出院6月时，59例缺血性脑卒中患者和20例TIA患者已停止使用抗血小板药物，停药率分别为21.5%（59/275）和66.7%（20/30）。停药原因依次分别是社区医生认为不需要使用（27.85%）、担心药物不良反应（22.78%）、自认为疾病好转不愿坚持服用（17.72%）、相信中成药物（17.72%）、就医不便（12.66%），经济原因（1.27%）。结论：缺血性脑血管病发病早期抗血小板药物应用比例较高，出院6月時依从性下降，需专科医师与全科医师共同努力提高缺血性脑血管病患者使用抗血小板药物的依从性。

关键词 缺血性脑血管病；抗血小板药物；社区

中图分类号：R743.31 文献标志码：A 文章编号：1006-1533（2017）22-0039-03

Application of anti-platelet agents in patients with ischemic cerebrovascular disease in the community

FENG Jianyu

（Ouyang Community Health Service Center of Hongkou District， Shanghai 200081， China）

ABSTRACT Objective： To understand the application of anti-platelet agents in patients with ischemic cerebrovascular disease in the community to provide the basis for improving secondary prevention effect of ischemic cerebrovascular disease. Methods： A total of 286 patients with ischemic stroke and 36 patients with transient ischemic attack （TIA） registered in this community were enrolled. The reasons for the use of anti-platelet agents， types and doses， and the absence of anti-platelet agents were analyzed at the time of discharge and after 6 months of discharge. Results： At discharge， 305 patients were treated with anti-platelet agents， of whom 275 were ischemic stroke patients and the medication rate was 96.2% （275/286）， and 30 cases were TIA patients， and the utilization rate was 83.3% （30/36）. When being discharged from hospital after 6 months， 59 patients with ischemic stroke and 20 patients with TIA had discontinued the use of anti-platelet agents， and the discontinuation rates were 21.5% （59/275） and 66.7% （20/30）. The reasons for withdrawal were followed by community doctors who thought they did not need to use （27.85%） and worrying about adverse drug reactions （22.78%）， thinking the improvement of the disease and unwilling to insist on taking （17.72%）， believing in Chinese medicine （17.72%）， medical service inconvenience （12.66%）， and economic reason （1.27%）. Conclusion： In the early stage of ischemic cerebrovascular disease， the proportion of anti-platelet drugs is higher， compliance declined after 6 months of discharge， and physicians and general practitioners are required to work together to improve compliance with anti-platelet agents in the patients with ischemic cerebrovascular disease.endprint

KEY WORDS ischemic cerebrovascular disease； anti-platelet agent； community

目前，脑血管疾病已经成为我国居民第一位死亡原因[1]，缺血性脑卒中和短暂性脑缺血发作（transient ischemic attack，TIA）是最常见的脑血管病类型，在我国脑卒中亚型中，缺血性脑卒中的比例高达近70%[2]。而缺血性脑卒中年复发率高达17.7%[3-4]。研究显示，积极的二级预防结合生活方式改变可以减少5年内缺血性卒中复发约80%，从而改善患者生存质量。抗血小板药物在缺血性脑血管病二级预防中占有重要地位[5]。……