缺血性卒中患者服药依从性影响因素分析

doi:10.3969/j.issn.1673-5765.2024.08.008

摘要/Abstract

摘要：

目的调查缺血性卒中患者服药依从性的影响因素。

方法前瞻性连续纳入首都医科大学附属北京天坛医院国际部2022年6月—2023年12月的缺血性卒中住院患者。采用问卷调查收集患者的一般情况、服药依从性[采用Morisky服药依从性量表（Morisky medication adherence scale，MMAS）评估]、感知健康能力[采用中文版感知健康能力量表（perceived health competence scale，PHCS）评估]、卒中复发情况等信息。根据MMAS评分将患者分为依从性差（MMAS评分＜６分）组和中高依从性（MMAS评分≥6分）组。比较两组的人口学特点、临床特点和血管危险因素情况，并采用多因素logistic回归分析服药依从性的影响因素。

结果共纳入缺血性卒中患者212例，平均年龄（59.9±5.9）岁，MMAS评分6（6～7）分，其中服药依从性差组41例（19.34%），中高依从性组171例（80.66%）。多因素logistic回归分析显示，初中及以下学历患者依从性差的风险是大专及以上学历患者的6.290倍（95%CI 1.912～20.689，P=0.002）；无配偶患者依从性差的风险是有配偶患者的4.172倍（95%CI 1.372～12.684，P=0.012）；无业患者依从性差的风险是在职患者的4.115倍（95%CI 1.326～12.773，P=0.014）；PHCS评分低水平的患者服药依从性差的风险是中等水平患者的2.190倍（95%CI 1.098～4.370，P=0.026）。中高依从性组患者出院后1个月（99.42% vs. 92.68%，P=0.004）、3个月（98.83% vs. 80.49%，P＜0.001）和6个月（98.25% vs. 75.61%，P＜0.001）的随访完成率均高于依从性差组；3个月（3.55% vs. 12.12%，P=0.038）、6个月（4.76% vs. 16.13%，P=0.019）的卒中复发率低于依从性差组。

结论初中及以下学历、无配偶、无业、PHCS评分低的缺血性卒中患者服药依从性差的风险较高。护理人员应综合考虑患者的个体差异，制订并实施个体化的健康教育计划，以提高患者的服药依从性。

文章导读： 服药依从性是保证卒中患者规范二级预防的重要方面。本前瞻性研究对缺血性卒中患者的服药依从性影响因素进行了分析，有利于临床进行针对性的用药指导，保证卒中二级预防策略的规范、长期执行，从而改善患者的预后。

关键词: 卒中; 服药依从性; 影响因素; 复发

Abstract:

Objective To investigate the influencing factors of medication adherence in ischemic stroke patients.

Methods This prospective study consecutively included the ischemic stroke inpatients at the international department of Beijing Tiantan Hospital, Capital Medical University from June 2022 to December 2023. A questionnaire was used to collect information on patients’ general information, medication adherence [evaluated by the Morisky medication adherence scale (MMAS)], perceived health competence [assessed by the perceived health competence scale (PHCS)], and stroke recurrence. The patients were divided into a poor adherence group (MMAS score<6) and a medium-high adherence group (MMAS score≥6) based on their MMAS scores. The demographic characteristics, clinical features, and vascular risk factors of the two groups were compared, and the influencing factors of medication adherence were analyzed using multivariate logistic regression analysis.

Results A total of 212 patients with ischemic stroke were included in this study, with a mean age of (59.9±5.9) years, and an MMAS score of 6 (6-7), of whom 41 cases (19.34%) belonged to the poor adherence group and 171 cases (80.66%) belonged to the medium-high adherence group. The multivariate logistic regression analysis showed that the risk of poor compliance in patients with a junior high school education or below was 6.290 times higher than that of patients with a college degree or above (95%CI 1.912-20.689, P=0.002); the risk of poor adherence in patients without a spouse was 4.172 times higher than that of patients with a spouse (95%CI 1.372-12.684, P=0.012); the risk of poor compliance in unemployed patients was 4.115 times higher than that of employed patients (95%CI 1.326-12.773, P=0.014); and the risk of poor compliance in patients with low PHCS scores was 2.190 times higher than that of patients with moderate PHCS scores (95%CI 1.098-4.370, P=0.026). Patients in the medium-high adherence group had higher follow-up completion rates at 1-month (99.42% vs. 92.68%, P=0.004), 3-month (98.83% vs. 80.49%, P＜0.001) and 6-month (98.25% vs. 75.61%, P＜0.001) after discharge than those in the low medication adherence group, and the difference was statistically significant. Meanwhile, the stroke recurrence rates of patients at 3-month (3.55% vs. 12.12%, P=0.038) and 6-month (4.76% vs. 16.13%, P=0.019) follow-up visits were lower than those of patients with low adherence, and the differences were statistically significant.

Conclusions Patients with a junior high school education or below, without a spouse, unemployed, and with a low PHCS score are at a higher risk of poor medication adherence. Nursing staff should consider the individual differences of patients comprehensively, and develop and implement personalized health education plans to improve patients’ medication adherence.

Key words:

Stroke; Medication adherence; Influencing factor; Recurrence

中图分类号:

薛明月, 张慧鑫, 苏丹, 李丽霞, 李晶玮, 李虹.

缺血性卒中患者服药依从性影响因素分析 [J]. 中国卒中杂志, 2024, 19(8): 909-914.

XUE Mingyue, ZHANG Huixin, SU Dan, LI Lixia, LI Jingwei, LI Hong.

Analysis of the Influencing Factors of Medication Adherence in Ischemic Stroke Patients [J]. Chinese Journal of Stroke, 2024, 19(8): 909-914.

参考文献

[1] TU W J，ZHAO Z P，YIN P，et al. Estimated burden of stroke in China in 2020[J/OL]. JAMA Netw Open，2023，6（3）：e231455[2024-02-01]. https://doi.org/10.1001/jamanetworkopen.2023.1455.

[2] CHEN Y P，WRIGHT N，GUO Y，et al. Mortality and recurrent vascular events after first incident stroke：a 9-year community-based study of 0.5 million Chinese adults[J/OL]. Lancet Glob Health，2020，8（4）：e580-e590[2024-02-01]. https://doi.org/10.1016/S2214-109X（20）30069-3.

[3] CHEILOUDAKI E，ALEXOPOULOS E C. Adherence to treatment in stroke patients[J/OL]. Int J Environ Res Public Health，2019，16（2）：196[2024-02-01].
https://doi.org/10.3390/ijerph16020196.

[4] LANK R J，LISABETH L D，LEVINE D A，et al. Ethnic differences in 90-day poststroke medication adherence[J]. Stroke，2019，50（6）：1519-1524.

[5] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.

Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：666-682.

[6] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志，2019，52（9）：684-709.

Chinese Society of Neurology，Chinese Stroke Society. Guidelines for the primary prevention of cerebrovascular diseases in China 2019[J]. Chin J Neurol，2019，52（9）：684-709.

[7] MORISKY D E，GREEN L W，LEVINE D M. Concurrent and predictive validity of a self-reported measure of medication adherence[J]. Med Care，1986，24（1）：67-74.

[8] SMITH M S，WALLSTON K A，SMITH C A. The development and validation of the perceived health competence scale[J]. Health Educ Res，1995，10（1）：51-64.

[9] 刘红霞，滕沙，林晓鸿，等. 中文版感知健康能力量表在肝移植人群中的信度、效度研究[J]. 中国护理管理，2015，15（9）：1067-1070.

LIU H X，TENG S，LIN X H，et al. The reliability and validity of the Chinese version of perceived health competence scale among liver transplant recipients[J]. Chinese Nursing Management，2015，15（9）：1067-1070.

[10] HSIEH C Y. Medication adherence and stroke prevention：what real world data tells us[J]. Acta Neurol Taiwan，2019，28（4）：86-87.

[11] ARKAN G，SARIGOL ORDIN Y，OZTURK V，et al. Investigation of medication adherence and factors affecting it in patients with stroke[J]. J Neurosci Nurs，2022，54（1）：35-41.

[12] 陈春燕，杨晓佳，罗志华. 家庭关怀度与老年脑卒中病人服药信念和服药依从性的相关性研究[J]. 全科护理，2021，19（34）：4860-4862.

CHEN C Y，YANG X J，LUO Z H. A study on the correlation between family caregiving and medication beliefs and medication adherence among elderly stroke patients[J]. Chinese General Practice Nursing，2021，19（34）：4860-4862.

[13] 张锐，冯绘绘，勾阳阳，等. 家庭关怀度与服药信念在老年缺血性卒中患者药物素养和服药依从性之间的中介作用[J]. 护理学杂志，2024，39（8）：20-24.

ZHANG R，FENG H H，GOU Y Y，et al. The mediating role of family function and medication belief in relationship between drug literacy and medication adherence in elderly patients with ischemic stroke[J]. Jounrnal of Nursing Science，2024，39（8）：20-24.

[14] 庞晨晨，陈素娟，冯英璞，等. 脑卒中患者健康行为的研究进展及展望[J]. 解放军护理杂志，2020，37（4）：63-65，68.

PANG C C，CHEN S J，FENG Y P，et al. The research progress and prospects of health behaviour in stroke patients[J]. Nurs J Chin PLA，2020，37（4）：63-65，68.

[15] 曾金艳，张亚，黄俏丽，等. 脑卒中偏瘫患者健康素养、健康行为与其肢体康复程度的相关性分析[J]. 中华保健医学杂志，2023，25（1）：43-46.

ZENG J Y，ZHANG Y，HUANG Q L，et al. Correlation analysis of health literacy，health behavior and degree of limb rehabilitation in stroke patients with hemiplegia[J]. Chin J Health Care Med，2023，25（1）：43-46.

[16] 杨士来，郑杰仁，辛惠明，等. 脑卒中病人感知健康能力与照顾者出院准备度的相关性研究[J]. 护理研究，2022，36（8）：1415-1419.

YANG S L，ZHENG J R，XIN H M，et al. Correlation between perceived health ability of stroke patients and discharge readiness of their caregiver[J]. Chinese Nursing Research，2022，36（8）：1415-1419.

[17] BACHMANN J M，MAYBERRY L S，WALLSTON K A，et al. Relation of perceived health competence to physical activity in patients with coronary heart disease[J]. Am J Cardiol，2018，121（9）：1032-1038.

[18] 刘梦如，梁发存，尹艳茹，等. 脑卒中患者健康素养的潜在剖面分析及与健康行为差异比较[J]. 军事护理，2023，40（4）：52-55，70.

LIU M R，LIANG F C，YIN Y R，et al. Latent profile analysis of health literacy and comparison of health behavior differences in patients with stroke[J]. Mil Nurs，2023，40（4）：52-55，70.

[19] 刘纤，万利源，严彤，等. 老年脑卒中患者健康信念与健康行为的现状调查[J]. 海南医学，2019，30（3）：370-373.

LIU X，WANG L Y，YAN T，et al. Investigation on health belief and health behavior of senile stroke patients[J]. Hainan Med J，2019，30（3）：370-373.

[20] 程永梅，唐晓磊，吴义金，等. 健康信念在非瓣膜性心房颤动患者疾病感知与服药依从性之间的中介效应研究[J]. 实用心脑肺血管病杂志，2023，31（5）：106-111.

CHENG Y M，TANG X L，WU Y J，et al. Mediating effect of health beliefs on disease perception and medication adherence in patients with non-valvular atrial fibrillation[J]. Pract J Cardiac Cereb Pneum Vasc Dis，2023，31（5）：106-111.