首发急性缺血性脑卒中患者服药依从性影响因素分析

Influencing factors for medication compliance in patients after first-episode acute ischemic stroke

摘要:

目的 分析首发急性缺血性脑卒中(AIS)患者服药依从性的相关影响因素。方法 纳入遂宁市中心医院神经内科2017年9月至2018年3月收治的首发AIS患者223例,根据Morisky服药依从性量表评分将患者分为服药依从性差组(评分＜6分)107例和服药依从性好组116例(评分≥6分),比较2组患者临床特征、1年后脑卒中复发和预后。应用SPSS 20.0统计软件对数据进行分析。多因素logistic回归分析服药依从性的影响因素。结果 服药依从性好患者比例为50.02%(116/223)。服药依从性好组相比服药依从性差组医保报销、月收入≥1500元、城市户口、高血压、糖尿病、服用降压药和降糖药患者比例高,农民、文化程度较低、1年后脑卒中复发和改良Rankin量表＜3分患者比例低,差异均有统计学意义(P＜0.05)。多因素logistic回归分析结果显示有医保报销(OR＝0.289,95%CI 1.326～9.002; P＝0.011)、服用降压药(OR＝2.451,95%CI 1.064～5.646; P＝0.035)和降糖药(OR＝9.515,95%CI 1.949～46.452; P＝0.005)是服药依从性的保护因素,而农民(OR＝0.320,95%CI 0.146～0.702; P＝0.004)、月收入＜1500元(OR＝0.471,95%CI 0.238～0.932; P＝0.031)、小学及以下文化程度(OR＝0.376,95%CI 0.168～0.844; P＝0.018)是服药依从性的危险因素。结论 服药依从性好的患者1年后脑卒中复发率低,预后更好,应积极管理无医保报销、月收入＜1500元、小学及以下文化程度、农民、未合并高血压、糖尿病及未服用降压药和降糖药患者。

Abstract:

Objective To analyze the influencing factors for medication compliance in patients with first-episode acute ischemic stroke (AIS). Methods A total of 223 AIS patients admitted in our Neurology Department from September 2017 to March 2018 were enrolled in this study. According to Morisky medication adherence scale, they were divided into poor compliance group (score<6 points, n=107) and good compliance group (score≥6 points, n=116). The clinical features, recurrence and prognosis 1 year later were compared between the 2 groups. SPSS statistics 20.0 was used to analyze the data. Multivariate logistic regression analysis was employed to analyze the influencing factors of medication compliance. Results The proportion of patients with good compliance was 50.02% (116/223). Compared with the poor compliance group, the good compliance group had significantly higher proportions of medical insurance reimbursement, monthly income (>￥1500), urban household registration, hypertension, diabetes mellitus, taking antihypertensive drugs, and taking antidiabetic drugs, while obviously lower proportions of farmers, lower educational level, recurrence of stroke after 1 year and having the score of Modified rankin scale<3 (all P<0.05). Multivariate logistic regression analysis showed that medical insurance reimbursement (OR=0.289,5%CI 1.326-9.002; P=0.011), taking antihypertensive drugs (OR=2.451,5%CI 1.064-5.646; P=0.035) and hypoglycemic drugs (OR=9.515,5%CI 1.949-46.452; P=0.005) were protective factors for drug compliance, while farmers (OR=0.320,5%CI 0.146-0.702; P=0.004), monthly income less than ￥1500 (OR=0.471,5%CI 0.238-0.932; P=0.031), educational level of primary school or lower (OR=0.376, 95%CI 0.168-0.844; P=0.018) were risk factors for drug compliance. Conclusion The patients with good medication compliance have a lower recurrence rate and better prognosis 1 year later. Active attention should be paid to management of the patients without medical insurance reimbursement, with monthly income less than ￥1500, with educational level of primary school or lower, farmers, without hypertension or diabetes mellitus, and having not taken antihypertensive and antidiabetic drugs.