脑卒中3年生存和复发的社区干预效果

Effects of Urban Community Intervention on 3-Year Survival and Recurrence After First-Ever Stroke

目的近20年来,脑卒中是中国人群的主要死亡原因,其发病率随着脑卒中危险因素的增加呈上升趋势。本研究旨在评价初发脑卒中患者3年生存和复发的社区干预效果。方法1991～2000年选择北京2个人口约50 000人的社区分别作为干预和对照社区。采取的综合干预措施包括高危人群管理和社区人群健康教育。对初发脑卒中3年生存和复发的社区干预效果进行评价。结果3年内干预社区736例患者中有41．85%的死亡,而对照社区818例患者中有40．34%的死亡;干预社区223例患者中有26人(11．66%)复发〔RR=0．74,95% CI为(0．61,0．89),P= 0．002〕,对照社区250例患者中有52人(20．80%)复发〔RR=0．61,95% CI为(0．46,0．81),P=0．001〕,2个社区的复发率间差别有显著性意义。对照社区比干预社区脑卒中死亡率下降了26%,尤其是出血性脑卒中下降了39%,同时复发率下降了42%。结论社区干预对预防脑卒中,尤其是出血性脑卒中的复发,改善脑卒中生存是有效的。

Objective For the past 2 decades,stroke has been a principal cause of death in China,and stroke inci- dence tends to increase with the increase of stroke-related risk factors.The purpose of this study was to evaluate the effects of urban community-based intervention on 3-year survival and recurrence after first-ever stroke.Methods Two communities with a registered population of≈50000 each were selected as either intervention or control communities in Beijing during 1991 to 2000.Comprehensive intervention measures including the management of high-risk population and the health education of whole community population were regularly implemented.Then the influence of community intervention on 3-year survival and recur- rence after initial stroke was evaluated.Results Within 3 years,41.85% of 736 patients in the intervention community died whereas 40.34% of 818 patients in the control community died.Of 223 cases from the intervention community,26(11.66%) had a recurrent stroke within 3 years versus 52(20.80%)of 250 cases from the control community.The statistical difference was found.Compared with the control community,the death risk of first-ever stroke in the intervention community decreased by 26%〔relative risk [RR]=0.74;95% confidence interval CI为(0.61,0.89);P=0.002〕;especially,that of hemor- rhagic stroke decreased by 39%〔RR=0.61 ;95% CI为(0.46,0.81);P=0.001〕.Compared with the control communi- ty,the recurrence risk of first-ever stroke from the intervention community decreased by 42%〔RR=0.58;95% CI为0.34, 1.00;P=0.048〕.Conclusion Community intervention maybe effective and beneficial to the recurrence prevention and surviv- al improvement of stroke,especially hemorrhagic stroke.