【作者】 张艳；

【导师】 李惠萍；

【作者基本信息】 安徽医科大学 ， 护理学， 2015， 硕士

【摘要】 目的探讨安徽省某三甲医院冠心病患者出院后1年抗血小板药物服用依从性及其影响因素,为冠心病患者的二级预防提供依据。方法采用横断面调查,方便选取2012年1~12月在安徽省某三甲医院经冠脉造影方法首次确诊为冠心病的患者398例,最终363例完成研究,通过自行设计调查表,在患者出院后1年时进行门诊或电话随访,评估患者出院后1年时的抗血小板药物服用依从情况、不依从原因。运用SPSS13.0对资料进行统计分析,采用Logistic回归分析法,分析影响冠心病患者服用抗血小板药物依从性的因素。结果冠心病患者出院后1年时服用抗血小板药物的情况:依从服用301例(83%,301/363),不依从服用62例(17%,62/363);不依从原因:随意停药38例(61%,38/62),医嘱停药14例(23%,14/62),经济原因停药7例(11%,7/62),不良反应停药3例(5%,3/62)。单因素分析显示:年龄(P=0.009,c2=9.425)、不同医疗付费方式(P=0.044,c2=6.262)、是否经皮冠状动脉介入治疗(PCI)(P=0.018,c2=5.556)、冠心病不同组别(稳定型心绞痛,不稳定型心绞痛,急性心肌梗死)(P=0.032,c2=6.895)是服药依从性的相关因素,其中年龄[P=0.004,OR=0.471(0.284~0.782)]、是否经皮冠状动脉介入治疗[P=0.020,OR=2.104(1.123~3.942)]是影响冠心病患者抗血小板药物服用依从性的主要因素。结论冠心病患者出院后1年抗血小板药物治疗存在非依从问题,医护人员在制定治疗及护理对策时应充分考虑患者年龄、是否行PCI治疗、医疗付费方式和冠心病的不同类型等因素,以提高服药依从性,做好冠心病患者的二级预防。更多还原

【Abstract】 Objective To analyze the compliance of antiplatelet therapy and its influencing factors in patients with coronary heart disease one year after hospitalization, so that an improvement will be made on the secondary prevention for coronary heart disease. Methods By cross-sectional investigation, the study enrolled 398 patients with first-diagnosed coronary heart disease in a certain grade-3 A hospital in Anhui Province from January to December 2012, and 363 of them completed the study at last. The therapeutic compliance of these patients, as well as the influencing factors, was evaluated with a self-designed questionnaire through either out-patient interview or phone revisit. The factors influencing therapeutic compliance of patients with coronary heart disease were analyzed with logistic regression analysis. Results The results showed that 301 patients(83%,301/363) were in a good therapeutic compliance, while the rest of 62 patients(17%,62/363) were not. The reasons of drug with drawal: arbitrary decisions being 38 cases(61%,38/62), the doctor’s advices 14 cases(23%,14/62), the economic dilemma 7 cases(11%,7/62), and adverse drug reaction 3 cases(5%,3/62). Simple factor analysis displays that ways of medical payment(P=0.044,c2=6.262), the condition whether with PCI treatment or not(P=0.018,c2=5.556), and the different groups of coronary heart disease(stable angina pectoris,unstable angina pectoris and acute myocardial infarction)(P=0.032, c2=6.895)were related to the compliance of antiplatelet therapy. The main influencing factors were the age[OR=0.471(0.284~0.782)] and the condition whether with PCI therapy or not [OR=2.104(1.123~3.942)]. Conclusions Patients with coronary heart disease had noncompliance in antiplatelet therapy one year after hospitalization. Therefore, medical staff should make treatment protocol and take nursing measures according to age, condition whether with PCI treatment or not, ways of medical payment and the different groups of coronary heart disease so that the medication compliance can be elevated and the secondary prevention well implemented.更多还原