慢性心力衰竭患者沙库巴曲缬沙坦钠片用药依从性影响因素及智能干预策略研究

Study on Influencing Factors of Medication Adherence to Sacubitril Valsartan Sodium Tablets and Intelligent Intervention Strategies in Patients with Chronic Heart Failure

摘要

目的 探讨影响慢性心力衰竭（chronic heart failure，CHF）患者口服沙库巴曲缬沙坦钠片用药依从性的关键影响因素，基于此构建智能化的干预策略，并评价其临床应用效果。方法 选取2022年10月至2024年2月衡水市第二人民医院收治的260例CHF患者为研究对象，均口服沙库巴曲缬沙坦钠片治疗。采用一般资料调查表、8项Morisky用药依从性量表（8-Item Morisky Medication Adherence Scale，MMAS-8）等开展横断面调查，以MMAS-8评分判断用药依从性，将患者分为依从性良好组（n=66）与依从性不佳组（n=194）。运用单因素分析和多因素Logistic回归分析筛选用药依从性的独立影响因素。将依从性不佳组患者随机分为对照组与观察组，每组97例。对照组接受常规用药指导，观察组在对照组基础上接受为期3个月的智能化干预。于干预1个月和3个月时，采用MMAS-8比较2组患者用药依从性；持续随访3个月，观察并统计不良反应发生率。结果 依从性良好组和依从性不佳组在居住情况、文化程度、家庭人均月收入、药物不良反应、疾病认知度得分、焦虑自评量表（Self-Rating Anxiety Scale，SAS）、抑郁自评量表（Self-Rating Depression Scale, SDS）、社会支持评定量表（Social Support Rating Scale, SSRS）等方面比较，差异具有统计学意义（P<0.05）；多因素Logistic回归分析显示，居住情况为独居、文化程度为小学及以下、家庭人均月收入≤3 000元、有药物不良反应、疾病认知度得分≤15.5分、SAS>53分、SDS>54分、SSRS≤34.5分均为影响CHF患者沙库巴曲缬沙坦钠片用药依从性的独立危险因素（P<0.05）。干预1个月和3个月，观察组MMAS-8评分高于对照组（P<0.05）。观察组低血压、高钾血症、血肌酐升高、头晕/乏力、咳嗽等不良反应发生率均低于对照组（P<0.05）。结论 CHF患者服用沙库巴曲缬沙坦钠片用药依从性受居住情况、文化程度、家庭人均月收入、药物不良反应、疾病认知度得分、焦虑抑郁情绪等因素影响。基于这些因素构建的智能化、个性化干预措施能有效提高患者用药依从性，降低不良反应，具有临床推广价值。

Abstract

Objective To explore the key influencing factors of the medication adherence of patients with chronic heart failure (CHF) to oral sacubitril valsartan sodium tablets, and to construct an intelligent intervention strategy based on this, and evaluate its clinical application effect. Methods 260 CHF patients admitted to Hengshui Second People's Hospital from October 2022 to February 2024 were selected as the study subjects, all of whom were treated with oral sacubitril valsartan sodium tablets. A cross-sectional survey was conducted using a general information questionnaire and an 8-Item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 score was used to determine medication adherence, and patients were divided into a good adherence group (n=66) and a poor adherence group (n=194). Univariate analysis and multivariate logistic regression analysis were used to screen independent influencing factors of medication adherence. Patients with poor adherence were randomly divided into a control group and an observation group, with 97 cases in each group. The control group received routine medication guidance, while the observation group received a 3-month intelligent intervention on the basis of the control group's routine guidance. At 1 and 3 months of intervention, MMAS-8 score was used to compare medication adherence between the two groups of patients; patients were followed up for 3 months, and the incidence of adverse reactions was observed and recorded. Results The good adherence group and the poor adherence group showed statistically significant differences in terms of living status, educational level, per capita monthly household income, adverse drug reactions, disease awareness score, Self-Rating Anxiety Scale (SAS) score, Self-Rating Depression Scale (SDS) score, Social Support Rating Scale (SSRS) score, and other aspects (P<0.05); Multivariate logistic regression analysis showed that living alone, education level of primary school or below,per capita monthly household income ≤ 3 000 yuan, adverse drug reactions, disease awareness score ≤ 15.5 points, SAS score > 53 points, SDS score > 54 points, SSRS score ≤ 34.5 points were all independent risk factors affecting the medication adherence of CHFpatients to sacubitril valsartan sodium tablets (P ＜ 0.05). After intervention for 1 month and 3 months, the observation group had a higher MMAS-8 score than the control group (P ＜ 0.05). The incidence of adverse reactions such as hypotension, hyperkalemia, elevated serum creatinine, dizziness/fatigue and cough in the observation group was lower than that in the control group (P ＜ 0.05). Conclusion The medication adherence of CHF patients taking sacubitril valsartan sodium tablets is influenced by factors such as living status, educational level, per capita monthly household income, adverse drug reactions, disease awareness score, anxiety and depression. Based on these factors, intelligent and personalized intervention measures can effectively improve patients' medication adherence, reduceadverse reactions, and have clinical promotion value.

关键词

沙库巴曲缬沙坦钠片 / 慢性心力衰竭 / 药物依从性 / 智能干预

Key words

sacubitril valsartan sodium tablets / chronic heart failure / medication adherence / intelligent intervention

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基金资助

衡水市科技计划项目(2019014092Z)