Stroke Vasc Neurol:我国中风防治有短板!王拥军等BMJ子刊发表全国注册研究

2020-07-30 朱朱 中国循环杂志

我国中风所致的死亡率明显低于西方国家,但我国中风患者住院时间较长,且溶栓药物、降脂药物、抗血小板药物、降压药物等循证药物的应用明显不足,而未证实疗效的一些药物(包括神经保护药物和中医药)却被广泛使用。

近期,北京天坛医院王拥军教授等发表的一项全国性注册登记研究表明,我国中风所致的死亡率明显低于西方国家,但我国中风患者住院时间较长,且溶栓药物、降脂药物、抗血小板药物、降压药物等循证药物的应用明显不足,而未证实疗效的一些药物(包括神经保护药物和中医药)却被广泛使用。

该研究结果说明,我国中风患者的管理还有很大的改善空间该研究显示,在我国缺血性中风、脑出血、蛛网膜下腔出血患者中,住院期间死亡率分别为3.2%、9.3%、10.1%,6个月时死亡率分别为8.6%、18.2%、22.0%。而在西方国家,缺血性中风患者住院期间和6个月时死亡率分别为5.6%和大约20%,脑出血患者6个月时死亡率高达39%。

研究者表示,这与我国中风住院患者病情相对较轻(缺血性中风和脑出血患者NIHS评分分别为4分和9分)有关。尽管我国中风患者死亡率相对较低,但存活者中6个月复发率达7.2%,明显高于西方国家(5%)。

在我国缺血性中风、脑出血、蛛网膜下腔出血患者中,住院期间复发率分别为2.6%、1.9%、7.2%,6个月时复发率分别为8.0%、5.1%、7.5%,主要血管事件(血管性死亡、中风复发、心肌梗死)发生率分别为16.5%、23.1%、28.4%。

研究者指出,我国中风复发率高,在一定程度上与已被证实疗效的二级预防药物应用不足有关。

在缺血性中风患者中,仅1.3%在症状发作3 h内接受溶栓治疗,但住院期间疗效未经证实的神经保护药物(例如,静脉用依达拉奉、神经节糖苷GM1、胞磷胆碱)和中医药(包括中草药和补充剂)的应用率高达69.7%和70.6%。

住院期间,缺血性中风患者中抗血小板治疗应用率为88.4%,但阿司匹林与氯吡格雷双联抗血小板治疗的应用率仅8%。在脑出血患者中,住院期间神经保护药物和中医药应用率分别为63.3%和36.3%。蛛网膜下腔出血患者中,住院期间神经保护药物和中医药应用率分别为59%和20%。出院时,缺血性中风患者中分别有70.7%和38.0%接受抗血小板药物和他汀类药物治疗,但6个月时这两类药物的应用率分别降至64.8%和23.9%。出院时仅1.5%的缺血性中风患者应用抗凝药物。

对于脑出血和蛛网膜下腔出血患者来说,降压药物是二级预防中最重要的药物。但出院时,仅51%和18%的脑出血和蛛网膜下腔出血患者应用降压药。

另外,我国中风患者中仅20%是在专业的卒中中心接受治疗,仅23%的患者是由救护车转运至医院的。

我国中风患者的住院时间也明显长于西方国家。我国出院时存活中风患者的平均住院时间长达18天,其中脑出血患者平均住院时间为21天,是西方国家的2倍左右。

研究者指出,我国中风患者住院时间较长,可能与国家医保报销主要覆盖住院治疗以及社区缺乏康复机构等因素有关。该研究于2007~2008年从我国31个省、直辖市、自治区的132家医院纳入14 244例经影像学检查确诊的首次中风住院患者,其平均年龄为62.5岁,60.6%为男士。其中,缺血性中风占68.7%,脑出血和蛛网膜下腔出血分别占26.9%和4.4%。在首次住院前,1/3以上的缺血性中风和脑出血患者服用降压药物,但仅1.8%的缺血性中风患者应用他汀类药物。中风患者住院期间最常见的并发症为肺炎,脑出血患者中发生率最高(16.1%)。

研究者表示,尽管该研究主要覆盖大中型城市医院,且研究对象是10年前纳入的,不能反映全国现在的中风管理现状,但是目前为止覆盖全国所有区域的最大规模注册登记研究,有助于估计未来医疗质量需要改善的程度以及医保系统的改革。他们认为,未来需要采用分层、多阶段取样法,进一步监测中国中风治疗模式的变化。另一个重要的事情是,要开展大规模随机临床试验,来评估在临床广泛使用但疗效未经证实的药物的有效性和安全性,尤其是神经保护药物和中医药。

原始出处:

Haiqiang Qin, Yiping Chen, Gaifen Liu,et al.Management characteristics and prognosis after stroke in China: findings from a large nationwide stroke registry.Stroke Vasc Neurol. 2020 Jun 22;svn-2020-000340. doi: 10.1136/svn-2020-000340.

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    2021-05-23 quxin068
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    2021-04-25 yinhl1978
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    2021-03-02 gaoxiaoe
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    2020-08-01 zhyy93
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    2020-07-30 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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