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目的观察医师培训和专病门诊对缩小临床实践与缺血性卒中二级预防指南差距的影响。方法选择在卒中专病门诊就诊的305例缺血性卒中患者,比较其在医师规范培训前后及出院与在专病门诊随访期间抗栓药、他汀类药物、不规范用药和降压药的使用情况。结果医师经培训后提高了二级预防用药的规范性,患者出院的抗栓药(79.3%比93.1%,P<0.01)和他汀类药(19.5%对59.2%,P<0.01)使用率显著提高,不规范用药(47.1%比27.5%,P=0.001)显著降低。高血压的治疗率(88.4%比94.0%)差异无统计学意义。与出院时相比,专病门诊随访患者的抗栓药和他汀类药使用率进一步提高,不规范用药进一步降低。出院带药规范者随访期的用药依从性高。结论医师培训能提高缺血性卒中二级预防处方的规范性,专病门诊能进一步提高患者出院带药及随访期用药的依从性。
Objective To observe the influence of physician training and special disease clinic on narrowing the gap between clinical practice and secondary prevention guidelines for ischemic stroke. Methods A total of 305 ischemic stroke patients were selected in outpatient department of Stroke specialist and compared with their control group before and after training and during hospital discharge and antithrombotics, statins, non-standard medication and antihypertensive drugs Usage. Results Physicians trained in secondary prophylaxis improved the use of antithrombotics (79.3% vs 93.1%, P <0.01) and statins (19.5% vs 59.2%, P <0.01) significantly after training Increased, non-standard medication (47.1% vs. 27.5%, P = 0.001) was significantly lower. Hypertension treatment rate (88.4% vs 94.0%) showed no significant difference. Compared with the time of discharge, the patients in special disease outpatient follow-up of patients with antithrombotic and statin use rate to further improve, non-standard medication to further reduce. Discharged drug normative follow-up period of drug compliance. Conclusion Physician training can improve the standardization of secondary prevention prescriptions for ischemic stroke. Specialized clinic can further improve the compliance of discharged patients with medication and follow-up medication.