上海市某社区卒中高危老年人群筛查与干预管理实施效果评价  

Evaluation of the effectiveness of screening-intervention management in elderly population at high risk of stroke in a community in Shanghai

作　　者：徐佩玉 余虹 蔡珍璋 张海洋 顾桢茂[2] 周婷 黄久仪[2] Xu Peiyu;Yu Hong;Cai Zhenzhang;Zhang Haiyang;Gu Zhenmao;Zhou Ting;Huang Jiuyi(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》2024年第10期671-677,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81573248);上海市奉贤区科技发展基金(20221439)。

摘　　要：目的评价社区卒中高危老年人群筛查与干预管理方案的实施效果。方法选择2019年5月至2022年7月参加上海市奉贤区泰日社区年度健康体检的老年(年龄≥60岁)人群作为筛查与干预对象。于2019和2020年分2个年度分别进行第一轮卒中高危人群筛查,2021年和2022年依次对2019和2020年的筛查人群进行第二轮卒中高危人群筛查(复查),选择2轮筛查中均接受过卒中高危筛查的人群(重叠人群)作为本研究的观察对象。采用脑血管功能积分值对卒中高危人群进行筛查,75~100分为非高危,<75分为高危,其中50~74、25~49、0~24分依次为轻、中、重度危险。收集所有筛查人群的基线和复查资料,包括收缩压、舒张压、超重或肥胖情况(体质量指数≥24 kg/m2)、空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸。完成筛查后,在筛查现场对被筛查者进行检测报告解读和首诊干预,并将筛查结果录入健康体检档案。首诊干预包括生活方式干预、危险因素干预和高危个体的治疗性干预。生活方式干预和危险因素干预采取发放卒中预防科普手册和个体化面对面指导的方式。高危个体的治疗性干预根据卒中风险评估结果、相关慢性病患病情况等指导抗血小板聚集药物治疗、他汀类药物治疗及脑血管的进一步检查与治疗等。项目实施前回顾性调查2018年度该社区的卒中发病情况,以比较卒中筛查-干预的年度变化。在实施干预管理的过程中进行全社区户籍人口卒中发病监测,监测方法为每年进行1次卒中发病登记,并与奉贤区疾病预防控制中心和金汇镇泰日派出所合作获取疾病预防控制中心提供的2018至2022年该社区卒中发病监测资料和派出所提供的死亡登记信息。结果2轮筛查重叠并符合纳入排除标准的对象共5188名,男2269名,女2923名,第一轮筛查�Objective To evaluate the effectiveness of screening-intervention management program for high risk population of stroke in community.Methods Participants aged≥60 years old in Tairi Community,Fengxian District,Shanghai from May 2019 to July 2022 were selected as screening and intervention objects.The first round of stroke high-risk group screening was conducted in 2019 and 2020 in two years respectively,and the second round of stroke high-risk group screening(re-screening)was conducted in 2021 and 2022 respectively for the 2019 and 2020 screening groups,and the groups who had received stroke high-risk screening in both rounds of screening(overlapping groups)were selected as the observation objects of this study.The cerebrovascular function score was used to screen the high-risk individuals of stroke,75-100 was classified as non-high-risk,<75 were classified as high risk,among which 50-74,25-49,0-24 were light,medium and severe risk,in turn.Baseline and follow-up data were collected for all screening groups,including systolic blood pressure,diastolic blood pressure,overweight or obesity,fasting blood glucose,glycated hemoglobin,triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,and blood uric acid.After the completion of screening,the test report interpretation and first diagnosis intervention were carried out on the screening site,and the screening results were recorded into the health examination file.The first intervention includes lifestyle intervention,risk factor intervention and therapeutic intervention for high-risk individuals.Lifestyle intervention and risk factor intervention were conducted through the distribution of popular science handbook for stroke prevention and individualized face-to-face guidance.Therapeutic intervention for high-risk individuals was guided by anti-platelet aggregation drug therapy,statin therapy,and further examination and treatment of cerebral vessels according to stroke risk assessment results and the incidence of related

关 键 词：卒中 一级预防 风险评估 血流动力学 

分 类 号：R473.2[医药卫生—护理学]