陈韶玲　刘娟娟　李平　李婷　严文娜

【摘要】 目的：探讨粤北地区缺血性脑卒中患者抗血小板药物院外用药依从性及其影响因素。方法：选取2018年1月-2019年3月粤北地区接受抗血小板药物治疗缺血性卒中患者716例。根据用药依从性评估表的内容对患者出院后10 d，1、3、6个月进行用药依从性评估，并对影响用药依从性的因素进行相关性分析。结果：在随访时间内脱落研究的患者共计44例，实际纳入患者672例，随访有效率93.9%（672/716）。随着时间的延长，患者用药依从性逐渐下降，对不同时间段缺血性脑卒中患者用药依从性进行趨势性字2检验发现，差异有统计学意义（字2=69.716，P<0.05）。单因素分析显示，用药依从性高和用药依从性差比较，在文化程度、医疗支出方式、复诊、接受医疗资源的困难程度、症状改善、高血压、糖尿病、对疾病和药物是否了解方面比较差异有统计学意义（P<0.05）。Logistic回归模型分析显示，对疾病和药物不了解、无复诊、接受医疗资源难度大、高血压、糖尿病是导致用药依从性差的独立危险因素（OR>1，P<0.05）。结论：粤北地区缺血性脑中患者院外用药依从性整体状况较差，随着用药时间延长，依从性下降，而影响用药依从性差的因素较多，应根据相关影响因素采取针对性的干预措施以及健康指导，以提高患者用药依从性。

【关键词】 粤北地区 缺血性脑卒中 抗血小板药物 用药依从性 相关性分析

doi：10.14033/j.cnki.cfmr.2020.21.074 文献标识码 B 文章编号 1674-6805（2020）21-0-04

Study on the Compliance of Antiplatelet Drugs with Non-hospital Medications and Analysis of Related Factors in Patients with Ischemic Stroke in Northern Guangdong/CHEN Shaoling， LIU Juanjuan， LI Ping， LI Ting， YAN Wenna. //Chinese and Foreign Medical Research， 2020， 18（21）： -183

[Abstract] Objective： To investigate the compliance of antiplatelet drugs with out-of-hospital medications and its influencing factors in patients with ischemic stroke in the Northern ??Guangdong. Method： A total of 716 patients who received antiplatelet drugs for ischemic stroke were selected from January 2018 to March 2019 in Northern Guangdong. According to the content of the medication compliance assessment form， patients were evaluated for medication compliance at 10 days， 1， 3， 6 months after discharge， and correlation analysis was performed on factors affecting medication compliance. Result： There were 44 patients who dropped out during the follow-up period， and 672 patients were actually included. The follow-up efficiency was 93.9% （672/716）. With the extension of time， the patient's medication compliance gradually decreased， and the trend of the medication compliance of patients with ischemic stroke in different periods was analyzed by the trend 字2 test， and the difference was statistically significant （字2=69.716， P<0.05）. Univariate analysis showed that there was a significant difference in the level of education compliance， medical expenditures， follow-up visits， difficulty of receiving medical resources， improvement of symptoms， hypertension， diabetes， and understanding of diseases and drugs （P<0.05）. Logistic regression model analysis showed that ignorance of disease and drugs， no re-examination， difficulty in receiving medical resources， hypertension， and diabetes were independent risk factors that led to poor medication compliance （OR>1， P<0.05）. Conclusion： The overall status of adherence to out-of-hospital medications in patients with ischemic brain in the Northern Guangdong region is poor. With prolonged medication duration， compliance decreases， and there are many factors affecting poor medication compliance. Targeted interventions should be taken according to relevant factors measures and health guidance to improve patient medication compliance.

[Key words] Northern Guangdong Ischemic stroke Antiplatelet drugs Medication compliance Correlation analysis

First-authors address： Yuebei Peoples Hospital， Shantou University Medical College， Shaoguan 512026， China

中国是全球脑卒中发病率最高的国家之一，卒中复发率高于全球水平，其中缺血性卒中占我国卒中的69.6%～79.8%[1]。与首次卒中相比，卒中复发使致残或死亡风险相对于未复发患者增加约9倍[2]，为此，缺血性脑卒中患者二级预防尤为重要，应尽早启动并长期维持以降低卒中复发率。抗血小板药物如氯吡格雷、阿司匹林等是临床常规治疗卒中的药物，已被广泛应用，但需要长期服药以确保临床疗效[3]，而药物治疗的依从性对二级预防的成效至关重要。AVAIL研究显示，缺血性卒中或TIA患者1年后的停药率高，仅65.9%的患者在出院1年时仍在服用出院时所处方的二级预防药物，其中抗血小板药物的服药率仅12.9%[4]。国内部分研究显示，几乎有1/3的急性脑血管病患者在出院后停用一种或多种二级预防药物，并且发现与某些患者层面、药物提供者层面和医院层面因素相关[5-6]。……