家庭医生协同干预管理高尿酸血症患者的效果  

Effect of family doctor collaborative intervention on hyperuricemia patients

作　　者：白雪林 陆敏 邵春海[2] 

机构地区：[1]上海市新泾镇社区卫生服务中心管理平台,上海200335 [2]复旦大学附属华山医院营养科,上海200040

出　　处：《世界临床药物》2016年第11期748-752,共5页World Clinical Drug

摘　　要：目的探讨高尿酸血症的社区健康管理模式。方法纳入191例高尿酸血症人群,分为干预组(n=103)和对照组(n=88),干预组患者由家庭医生协同三级医院风湿科和营养科医生共同制订社区干预策略,包括指导急性发作期药物治疗及饮食生活习惯,并发症的防治以及双向转诊指征的判定等,干预为期18个月,对照组除维持原有药物治疗外不给予任何管理措施。干预结束后两组通过检测血尿酸、血糖、血脂、血尿素氮血肌酐和血清维生素C(Vit C)等生化指标,记录生活质量、疼痛状况、用药及饮食运动情况,评估社区干预管理的效果。结果干预后,干预组和对照组血尿酸水平均较干预前显著下降(P<0.01),干预组干预后血清Vit C、尿pH值较干预前明显提高,血肌酐、甘油三酯指标较干预前显著降低,差异均有统计学意义(P<0.01),对照组空腹血糖明显增加(P<0.05);干预后组间比较显示,干预组甘油三酯、血肌酐水平均显著低于对照组,血清VitC高于对照组,差异均具有统计学意义(P<0.05)。干预组干预后躯体功能维度评分、心理功能维度评分及总分均较干预前显著升高(P<0.01),疼痛评分显著降低(P<0.05),对照组仅心理功能维度评分较前显著升高(P<0.05),其他维度评分和总分及疼痛评分均无明显改变(P>0.05);干预后组间比较显示,干预组社会功能维度评分及总分明显高于对照组(P<0.05),疼痛评分明显低于对照组(P<0.05)。结论家庭医生协同制定社区综合干预策略可显著改善高尿酸血症患者血生化指标和血清Vit C,提高患者生活质量并降低疼痛评分,效果优于未干预者。Objective To explore the effect of community health management manner for hyperuricemia patients. Methods A total of 191 patients with hyperuricemia were collected and divided into intervention group （n=103） and control group （n=88）. For the patients of intervention group, the family doctors worked together with rheumatologists and nutritionists and defined the community intervention strategy. The patients of control group were giving drug treatment. After 18 month intervention, the blood uric acid, blood glucose, blood lipids and other biochemical indicators were observed in two groups, and the clinical effect and the effect of community intervention were evaluated. Results After intervention, blood uric acid levels were decreased significantly in both intervention group and control group （P〈0.01）, compared with before intervene, serum VitC and urine pH were increased, the serum creatinine and blood triglyceride level were lower in intervention group （P〈0.01）; the fasting glucose in control group increased sigficantly （P〈0.05）. Between the two groups, the levels of triglyeeride and creatinine in the intervention group were significantly lower than those in the control group, and the serum VitC level was higher than that in the control group （P〈0.05）. Compared with before intervene, the body function, psychological function dimension points and total scores were significantly elevated in intervention group（P〈0.01）, there was also significant difference in pain scores （P〈0.05）. There were only psychological function dimension scores significantly increased in control group （P〈0.05）. Compared with control group, imension of social function and total scores in intervention group were obviously higher （P〈0.05）, pain scores were significantly lower （P〈0.05）. Conclusion Community collaborative intervention strategy with family doctor against hyperuricemia patients can improve the biochemical indexes, pain scores and life quality, which is better than that of

关 键 词：家庭医生 高尿酸血症 社区综合干预 生活质量 疼痛评分 

分 类 号：R589[医药卫生—内分泌]