急性冠状动脉综合征患者二级预防用药现状及影响因素分析

摘要

目的 调查急性冠状动脉综合征(ACS)患者出院6个月医生对指南推荐二级预防药物的开药情况、患者的使用情况及相关因素.方法 对102例ACS的患者进行临床资料的登记和分析,半年后通过电话进行随访；根据患者在出院后6个月的处方药分为用药组和未用药组,并对其影响因素进行统计分析.结果 抗血小板药、β受体阻滞剂、ACEI/ARB和他汀类药物的开药率,在出院带药时分别为96.1％,67.6％,53.9％,83.3％；出院后3个月分别为94.1％,48.0％,43.1％,78.4％；出院后6个月依次为88.2％,43.1％,33.3％,75.5％.出院时,医生是否开β受体阻滞剂和他汀类药物均与患者家庭月收入和既往患有高脂血症史相关,ACEI/ARB只与既往患有高血压相关,他汀类药物与患者的血脂情况无关；出院后3个月,医生是否开ACEI/ARB与既往患有高血压相关,他汀类与饮酒史和既往患有高血压相关；出院后6个月,医生是否开抗血小板药与本次疾病诊断和本次是否植入支架相关,β受体阻滞剂与BMI和既往PCI史相关,ACEI/ARB与心血管家族史和既往患有高血压相关,他汀类与既往是否植入支架相关.出院后6个月,ACS患者抗血小板药、β受体阻滞剂、ACEI/ARB和他汀类药物服药率分别为87.3％,41.2％,19.6％,68.6％.其中,抗血小板药、β受体阻滞剂和他汀类药物使用情况均与医生在出院6个月是否开处方药相关.结论 ACS患者出院6个月内,β受体阻滞剂和ACEI/ARB类药物的开药率随着出院时间的延长而下降,ACEI/ARB类药物的开药率和用药率最低,且ACEI/ARB类药物的治疗依从性下降.%Objective To investigate prescriptions,usage and influencing factors of the secondary prevention medication for patients with acute coronary syndrome (ACS) in six months after discharge.Methods Totals of 102 patients with ACS were documented and analyzed,and followed up by phone for six months.According to the prescriptions during six months after discharge,they were divided into the users and non-users,and influencing factors were analyzed.Results Drug-prescribing rates of antiplatelet drugs,β-blockers,ACEI/ARB,and statins were respectively 96.1％,67.6％,53.9％ and 83.3％ at discharge,94.1％,48％,43.1％ and 78.4％ in three months,88.2％,43.1％,33.3％ and 75.5％ in six months.At discharge,whether doctor had prescribed β-blockers and statins was affected by income and history of hyperlipidemia,and prescription of ACEI/ARB only related with history of hypertension.After three months,prescription of ACEI/ARB related with history of hypertension,and statins was affected by history of drinking and hypertension.After six months,antiplatelet drug prescription was impacted by disease diagnosis and implanted stents during this hospitalization or not,β-blocker was associated with BMI and history of PCI,ACEI/ARB was related with family history of cardiovascular disease and history of hypertension,and statins was related with history of implanted stents.Drug-taking rates of antiplatelet drugs,β-blockers,ACEI/ARB,and statins were respectively 87.3％,41.2％,19.6％ and 68.6％.And antiplatelet drugs,beta-blockers and statins,drug usage in 6-month were affected by whether doctor had prescribed these medication in six month after discharge.Conclusions During 6 months of follow-up,drug-prescribing rates of β-blockers and ACEI/ARB were decreased,as well as the medication compliance of ACEI/ARB,and drug-prescribing and taking rates of ACEI/ARB were the lowest.