心血管疾病高危人群临床预防性服务和生活方式调整综合干预效果评价  

Evaluation on the effect of comprehensive intervention combined with clinical preventive services and lifestyle adjustment among high-risk populations of cardiovascular disease in Tongxiang City

作　　者：郭丽花[1] 钟节鸣[1] 方乐[1] 陈向宇[1] 龚巍巍[1] 谢开婿[2] 王春梅[2] Guo Lihua;Zhong Jieming;FangLe;Chen Xiangyu;Gong Weiwei;Xie Kaixu;Wang Chunmei(Department of Chronic Non-communicable Diseases Control and Prevention,Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,China)

机构地区：[1]浙江省疾病预防控制中心慢性非传染性疾病预防控制所,杭州310051 [2]浙江省桐乡市疾病预防控制中心慢性非传染性疾病预防控制科,314500

出　　处：《中华预防医学杂志》2020年第4期411-415,共5页Chinese Journal of Preventive Medicine

基　　金：2015年度浙江省公益性技术应用研究计划(2015C33099)。

摘　　要：目的评价临床预防性服务和生活方式调整相结合的综合干预对心血管病高危人群的效果。方法2015年通过典型抽样方法选取浙江省桐乡市的河山镇、龙翔街道、梧桐街道和凤鸣街道等4个乡镇(街道),以整群随机对照试验的方法将其分配至干预组(河山镇和龙翔街道)和对照组(梧桐街道和凤鸣街道),在各乡镇(街道)50~74岁人群中招募10年心血管病发病风险≥10%的社区管理高血压患者,其中干预组1823例,对照组1883例。对干预组进行为期1年的临床预防性服务和生活方式调整相结合的综合干预,对照组进行常规慢病管理。干预完成后进行终末问卷调查并收集健康体检资料,以死亡、冠心病急性事件和脑卒中发病情况为主要结局,以心血管疾病相关知识和行为、临床预防性服务利用情况、体格变化、血脂指标和10年心血管疾病发病风险为次要结局,采用双重差分模型对干预效果进行评价。结果干预组和对照组年龄分别为(68.76±3.75)和(67.90±4.56)岁。经过1年干预,干预组的死亡率、冠心病急性事件发生率和脑卒中发生率分别为1.65%(30例)、0.27%(5例)和2.69%(49例),与对照组[分别为1.33%(25例)、0.32%(6例)和2.07%(39例)]的差异均无统计学意义(P值均>0.05)。调整年龄、性别、文化程度、婚姻状况、自我评估家庭收入水平和服用降压药情况等因素后,与对照组相比,干预组的体重指数和舒张压分别下降0.33 kg/m2和1.49 mmHg(1 mmHg=0.133 kPa);阿司匹林知晓率、他汀类知晓率、每天吃蔬菜比例、盐、油摄入量知晓率分别升高26.22%、29.56%、4.76%、10.80%、15.17%(P<0.05)。结论经过1年的综合干预,心血管疾病高危人群主要结局指标尚未有变化,次要结局指标体重指数、舒张压有所下降,心血管疾病相关知识的知晓率有所提高。Objective To evaluate the effect of comprehensive intervention combined with clinical preventive services and lifestyle adjustment on high-risk populations of cardiovascular disease.Methods In 2015,4 towns(streets)in Tongxiang City,of Zhejiang Province including Heshan Town,Longxiang Street,Wutong Street,and Fengming Street,were selected by using the typical sampling.The towns(streets)were allocated to the intervention group(Heshan Town and Longxiang Street)and the control group(Wutong Street and Fengming Street)by using the cluster random sampling.In each town(street),hypertension patients aged 50 to 74 years old who were taking community medicine management and with a 10-year cardiovascular disease risk≥10%were recruited as subjects.There were 1823 subjects in the intervention group and 1883 in the control group.The intervention group was given a 1-year comprehensive intervention combining clinical preventive services and lifestyle adjustment,while the control group received routine chronic disease management.After the intervention,the final questionnaire investigation was conducted and health physical examination data were obtained.The death,acute coronary heart disease events and stroke incidence were the primary outcomes,and cardiovascular disease-related knowledge and behavior,clinical preventive services utilization,physical changes,blood fat index and 10-year cardiovascular disease risk were the secondary outcomes.The difference-in-difference model was used to evaluate the effects of interventions.Results The age of subjects in the intervention and control group was(68.76±3.75)and(67.90±4.56)years old,respectively.After 1-year intervention,the incidence of mortality,acute coronary events and stroke in intervention group was 1.65%(30 cases),0.27%(5 cases)and 2.69%(49 cases),respectively,which showed no statistical difference compared to the control group[1.33%(25 cases),0.32%(6 cases)and 2.07%(39 cases)].After adjusting for the age,gender,education,marital status,self-assessed family income level and s

关 键 词：心血管疾病 高血压 生活方式 综合预防 

分 类 号：R54[医药卫生—心血管疾病]