某社区老年人群卒中一级干预方案实施效果的初步评价  

Preliminary evaluation of the effect of primary stroke prevention program in community elderly population

作　　者：陈庆华 黄久仪[2] 余虹 王艳[2] 徐佩玉 郭吉平[2] 顾桢茂[2] 李学松[2] Chen Qinghua;Huang Jiuyi;Yu Hong;Wang Yan;Xu Peiyu;Guo Jiping;Gu Zhenmao;Li Xuesong(Tairi Community Health Service Center,Jinhui Town,Fengxian District,Shanghai 201405,China;不详)

机构地区：[1]上海市奉贤区金汇镇泰日社区卫生服务中心,201405 [2]上海市脑血管病防治研究所

出　　处：《中国脑血管病杂志》2022年第2期88-93,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81573248);上海市科学技术委员会科研计划项目(19ZR1446300、21ZR1456500)。

摘　　要：目的初步评价某社区老年人群卒中一级干预方案的实施效果。方法选择上海市奉贤区某社区2019年参加社区老年健康体检并于2021年再次参加健康体检的老年人群作为研究对象。纳入社区人群的年龄≥60岁。以社区卫生服务中心为依托,以社区老年人年度健康体检结果为数据来源。在体检过程中进行一般情况调查,并进行卒中风险评估、卒中高危人群筛查、结合风险评估结果进行首诊干预,针对高危个体进行长期干预管理。卒中风险评估指标为脑血管功能积分,75~100分为非高危,50~<75分为轻度危险,25~<50分为中度危险,0~<25分为重度危险。干预2年后结合体检进行脑血管功能复检,比较干预前后脑血管功能积分及血压、身高、体质量、血脂、血糖、糖化血红蛋白的变化。结果(1)完成2019年筛查和2021年复检的某社区老年人群共计2333名,其中男1039名,女1294名。(2)与2019年初筛的结果比较,2021年男性收缩压(<140、140~159、≥160 mmHg)、舒张压(<90、90~99、≥100 mmHg)和女性舒张压(<90、90~99、≥100 mmHg)的分布均有改善,干预前后的差异均有统计学意义[58.5%(608/1039)、31.7%(329/1039)、9.8%(102/1039)比54.1%(562/1039)、32.5%(338/1039)、13.4%(139/1039),χ^(2)=7.610,P=0.022;78.4%(815/1039)、16.8%(175/1039)、4.7%(49/1039)比65.2%(677/1039)、24.7%(257/1039)、10.1%(105/1039),χ^(2)=48.693,P<0.01;76.7%(993/1294)、18.9%(245/1294)、4.3%(56/1294)比68.2%(883/1294)、23.6%(306/1294)、8.1%(105/1294),χ^(2)=28.166,P<0.01],但女性健康体检人群干预前后收缩压水平分布的差异无统计学意义(P>0.05)。(3)与2019年初筛的结果比较,2021年男性和女性三酰甘油、低密度脂蛋白降低,空腹血糖水平升高,差异均有统计学意义[男性:1.15(0.81,1.62)mmol/L比1.20(0.85,1.76)mmol/L,Z=-3.983;(2.44±0.65)mmol/L比(2.66±0.70)mmol/L,t=-14.800;4.9(4.5,5.6)mmol/L比4.8(4.4,5.4)mmol/L,Z=5.180;女性:1.39(1.01,1.99)mmol/L比1.44(1.03,1.Objective To evaluate the effect of primary stroke prevention program in a community elderly population.Methods The elderly population in a community in Fengxian District of Shanghai who participated in the community health physical examination for the elderly in 2019 and again in 2021 were selected as the research objects.The age of the population recruited in the community is≥60 years.Based on the community health service center,the annual physical examination results of the elderly in the community were used as data sources.A general investigation was conducted during the examination.The prevention program also included screening high-risk population of stroke during physical examination,first-visit intervention combined with risk assessment results,and long-term intervention management for high-risk individuals.The risk assessment index of stroke was cerebrovascular function score,and 75-100 points were non high risk,50-<75 points were mild risk,25-<50 points were moderate risk,and 0-<25 points were severe risk.After 2 years intervention,combined with physical examination,the cerebrovascular function was re-examined,and the changes of cerebrovascular function score,blood pressure,height,body weight,blood lipid,blood glucose and glycosylated hemoglobin A1c were compared before and after intervention.Results(1)A total of 2333 patients completed the 2019 screening and 2021 reexamination,including 1039 males and 1294 females.(2)Compared with the results of the initial screening in 2019,the proportion of systolic(<140,140-159 and≥160 mmHg)and diastolic blood pressure levels(<90,90-99 and≥100 mmHg)increased in males and diastolic blood pressure levels(<90,90-99 and≥100 mmHg)increased in females in 2021 were significantly lower,with statistically significant differences before and after intervention(58.5%[608/1039],31.7%[329/1039],9.8%[102/1039]vs.54.1%[562/1039],32.5%[338/1039],13.4%[139/1039],respectively,χ^(2)=7.610,P=0.022;78.4%[815/1039],16.8%[175/1039],4.7%[49/1039]vs.65.2%[677/1039],24.7%[257/1039],1

关 键 词：卒中 健康状况指标 危险因素 危险性评估 社区参与研究 脑血管功能检测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]