复发性脑梗死患者他汀类药物用药依从性情况调查

摘要

目的：对复发性脑梗死患者首次发病后使用他汀类药物情况进行调查，探讨引起其临床应用不规范的主要因素。方法从医院2007年9月至2013年12月住院的670例脑梗死患者中筛选出复发性动脉粥样硬化性血栓性脑梗死130例，调查其住院前使用他汀类药物的情况，分析他汀类药物使用不规范的原因。结果95例（73.08%）患者出院后他汀类药物使用不规范，其中19例（14.62%）虽坚持服用但低密度脂蛋白胆固醇未达标，56例（43.08%）间断服用他汀类药物；20例（15.38%）未服用他汀类药物。他汀类药物使用不规范的主要原因为，患者担心不良反应（如长期服用导致肝功异常）；患者对脑梗死复发认识不足；患者或家属认为无效；患者未坚持内科门诊随访，未接受专科医生指导；门诊医生随访中忽略询问使用情况；患者嫌麻烦；患者因出现副作用而停药。结论相当多的脑梗死患者他汀类药物使用不规范及未能坚持长期服用，调脂达标率较低。应对脑梗死患者加强脑卒中二级预防健康教育，以提高他汀类药物的用药依从性。%Objective To investigate the use situation of statins after the first attack in the patients with recurrent cerebral infarction, and to eXplore some main causes leading to non - standardization in its clinical application. Methods 130 cases of recurrent arterial atherosclerotic cerebral infarction were screened out from 670 cases of cerebral infarction in our hospital from September 2007 to march 2013 and performed the investigation on their use situation of statins before admission for analyzing the causes of non - standardized statins use. Results Among 130 cases of recurrent arterial atherosclerotic cerebral infarction, 95 cases (73. 08% ) had the non - stan-dardized statins taking after discharge from hospital, while 19 cases (14. 62% ) insisted on taking statins; 56 cases (43. 08% ) took statins interruptedly; 20 cases (15. 38% ) did not take statins; the main causes of non - standardized use of statins were as follows: wor-rying about the unwanted adverse reactions(such as leading to abnormal liver function by long term statins taking), insufficient recogni-tion on stoke recurrence; the patients or family members thought that statins were invalid; the patient did not insist the follow up of the internal medicine clinic and did not receive the guidance of the professional doctor; inquiring the statin use situation was ignored in the outpatient doctor follow up; the patient felt trouble for taking drug daily; the patient stopped taking statins due to appearance of side ef-fects. Conclusion A considerable proportion of the patients with cerebral infarction use statins with non - standardization and without long term insistent taking, the reaching standard rate for decreasing lipid is lower. So the secondary prevention health education on the stroke patients should be strengthened for enhancing their compliance on statins use.