再发急性冠脉综合征患者冠心病二级预防药物治疗依从性研究

再发急性冠脉综合征患者冠心病二级预防药物治疗依从性研究张晓，黄至齐，陈牧雷*目的　调查再发急性冠脉综合征（ACS）患者再发ACS时间间隔及既往ACS发作次数与冠心病二级预防药物治疗依从性的关系。方法　连续性选取2016年7—11月首都医科大学附属北京朝阳医院因再发ACS住院的319例患者为研究对象，采用横断面调查的方法收集患者冠心病二级预防药物服用情况，包括抗血小板药物、他汀类药物、β-受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）类药物，并调查患者再发ACS时间间隔、既往ACS发作次数。按照再发ACS时间间隔分为3组，即：再发ACS时间间隔≤1年（A组，n=82），1年<再发ACS时间间隔≤3年（B组，n=93），再发ACS时间间隔>3年（C组，n=144）；按照既往ACS发作次数分为2组，即既往ACS发作1次（1组，n=207），既往ACS发作次数≥2次（2组，n=112）。分别采用χ2检验分析患者再发ACS时间间隔及既往ACS发作次数与冠心病二级预防药物服用率的关系。结果　不同再发ACS时间间隔患者β-受体阻滞剂、ACEI/ARB类药物服用率比较，差异无统计学意义（P>0.05）；不同再发ACS时间间隔患者抗血小板药物及他汀类药物服用率比较，差异有统计学意义（P<0.05）；其中C组患者抗血小板药物及他汀类药物服用率较A组和B组降低（P<0.01）。不同既往ACS发作次数患者他汀类药物、β-受体阻滞剂及ACEI/ARB类药物服用率比较，差异无统计学意义（P>0.05）；2组患者抗血小板药物服用率高于1组（P<0.05）。结论　再发ACS患者冠心病二级预防药物服用率低，抗血小板药物及他汀类药物服用率随再发ACS时间间隔的延长而降低，提示随着时间的延长，ACS患者冠心病二级预防药物治疗意识下降，因此，有必要不断强化ACS患者的治疗意识，以提高冠心病二级预防药物治疗的依从性。

Evaluation of Adherence to Secondary Preventive Drugs in Patients with Recurrent Acute Coronary Syndrome

Objective　To evaluate the association of adherence to secondary preventive drugs with the interval between episodes of acute coronary syndrome（ACS） and previous episodes of ACS in patients with recurrent ACS.Methods　This cross-sectional study was conducted in 319 consecutive cases of recurrent ACS who received inpatient treatment in Beijing Chao-Yang Hospital，Capital Medical University between July and November，2016.We collected the patients' data about use of secondary preventive drugs for ACS〔antiplatelet drugs，statins，beta-blockers，angiotensin converting enzyme inhibitors（ACEI） or angiotensin Ⅱ receptor antagonist（ARB）〕，as well as the interval between episodes of ACS and previous episodes of ACS.Based on the interval between episodes of ACS，we assigned those with interval between episodes of ACS ≤1 year，>1-3 years，>3 years to group A（n=82），group B（n=93） and group C（n=144），respectively.And according to the previous episodes of ACS，we assigned those with once previous episode，≥2 times of episodes to group 1（n=207） and group 2（n=112），respectively.Chi-square test was used to analyze the association of adherence to secondary preventive drugs with the interval between episodes of ACS and previous episodes of ACS.Results　The rate of administration of beta-blockers，ACEI or ARB did not differ significantly between the patients by the interval between episodes of ACS（P>0.05）．In contrast，the rate of administration of antiplatelet agents and statins differed significantly between the patients by the interval between episodes of ACS（P<0.05）．Specifically，it was lower in group C than in groups A and B（P<0.01）．The rate of administration of statins，beta-blockers，and ACEI or ARB did not differ obviously between the patients by previous episodes of ACS（P>0.05）．The rate of administration of antiplatelet agents in group 2 was higher than that of group 1（P<0.05）．Conclusion　Among patients with recurrent ACS，the rate of administration of secondary preventive drugs was decreased；and the rate of administration of antiplatelet drugs and statins was reduced with the extension of the interval between episodes of ACS，indicating the awareness of taking secondary preventive drugs for ACS was decreased over time.Therefore，it is necessary to continuously strengthen the treatment consciousness of ACS patients to improve the adherence to secondary preventive drugs.