复发性缺血性脑卒中患者二级预防措施执行情况调查

目的分析复发性缺血性脑卒中患者二级预防措施依从性,总结二级预防失败患者药物治疗不当的原因和教训。方法登记2008年5月至2011年6月因再发脑梗死入院患者,按改良TOAST分型进行基线资料以及二级预防执行情况分析,从抗血小板药物使用、血压控制、他汀药物使用情况、糖尿病、吸烟等5个方面调查二级预防措施长期执行情况。结果急性缺血性脑卒中638例,其中复发性缺血性脑卒中106例,动脉粥样硬化血栓形成是最主要的病因类型(78.3%),其两次卒中事件时间间隔小于小血管病变(P<0.05)。二级预防措施执行情况分析显示69.4%患者未规律服用抗血小板药物,54.5%高血压患者血压控制不达标,87.7%高脂血症患者未达到血脂控制目标,76.5%糖尿病患者血糖不达标,86.7%吸烟患者未戒除吸烟。结论二级预防各项措施与指南之间均存在较大差距,迫切需要在基层医务人员和患者中强化二级预防的教育。

A Survey on execution of secondary prevention regimen for patients with recurrent ischemic stroke

Objective To investigate the long-term compliance to secondary prevention regimens for patients with recurrent ischemic stroke and analyze the main reasons for the abortion of secondary prevention regimen.Methods Patients with recurrent ischemic stroke were consecutively registered during May 2008 to June 2010.Baseline characteristics of three subtypes were analyzed based on the new TOAST classification.The survey on five measurements including antiplatelet agents or oral anticoagulants,antihypertensive,statins,diabetes mellitus drugs and smoking were used to evaluate the implementation of secondary prevention.Results Recurrent ischemic stroke occurred in 106 patients of total 638 patients with acute ischemic stroke.Atherothrombosis was the commonest subtype and accounted for 78.3% of recurrent ischemic stroke.The time interval between two attacks was shorter in atherothrombosis than in small vessel diseases(P<0.05).Sixty-nine point four % of patients had no regular use of antiplatelet;54.5% of patients with hypertension did not have their hypertension under control;87.7% of patient with hyperlipidemia patients did not keep their lipids under control;76.5% of patients with diabetes did not have their blood under control and 86.7% of smokers did not quit smoking.Conclusions The long term compliance of first-ever stroke patients to secondary prevention intervention is far from satisfactory and there is a huge gap between clinical practice and guideline.Therefore,it is urgent to enhance guideline training for primary caregivers and stroke patients to prevent stroke recurrence.