北京地区缺血性脑卒中或短暂性脑缺血发作二级预防的研究

目的对入院的缺血性脑卒中或短暂性脑缺血发作(TIA)患者采取ABCDE策略治疗,分析患者出院后能否维持高水平药物治疗的符合率。方法选择2007年8～12月连续收入北京地区21家医院神经内科病房的缺血性脑卒中和(或)TIA患者1166例,记录患者二级预防中抗血小板、降压、降糖及调脂药物等治疗情况,出院后对患者进行随访,分析出院后90d、6个月和1年二级预防中抗血小板、降压、降糖和调脂治疗的符合率。结果 1166例患者中,复发性脑卒中541例,其抗血小板治疗比例为58.4%,降压、降糖和他汀类药物治疗比例分别为82.3%、85.3%和14.2%。出院后,完成90d、6个月及1年随访的患者分别为1012例、1012例和981例,其二级预防中抗血小板、降压、降糖和调脂治疗的符合率维持在较高水平。结论复发性脑卒中二级预防现状不容乐观,采取ABCDE策略治疗,对入院的缺血性脑卒中或TIA患者进行规范干预后,明显缩小二级预防循证证据与临床实践的差距,患者出院后,二级预防治疗的符合率维持在较高水平。

Study on secondary prevention of ischemic stroke or TIA in Beijing

Objective To determine if adopt ABCDE strategies can maintain high medication coincidence rates after discharge from hospital.Methods From August 2007 to Dec 2007,a total of 1166 ischemic stroke or TIA patients were admitted into neurology wards of 21 hospitals in Beijing. Status of secondary prevention of stroke was analyzed by software SPSS 11.5,focusing on the compliance rate of medication in antiplatelet,antihypertension,antidiabetes and lipid-lowering therapy in hospital and discharge from hospital.Results There were 541 recurrent stroke patients, antiplatelet therapy rate in them was 58.4% ,antihypertension,antidiabetes and lipid-lowering therapy rates were 82.3%,85.3% and 14.2% respectively.There were 1166 patients discharged. Of them,1012 completed 90-days and six-months follow-up,and 981 completed one-year follow-up.The compliance rate of medication in antiplatelet,antihypertension,antidiabetes and lipid-lowering therapy was kept at a high level.Conclusion The status of secondary prevention of recurrent stroke can not be optimistic.Adopting ABCDE treatment strategy to carry out standard intervention for the admitted ischemic stroke/TIA patients significantly narrows the secondary prevention gap between evidence-based medicine and clinical practice,and makes medication compliance rate at a high level after discharge.