冠心病患者危险因子的社区干预研究

Study on community intervention of risk factors of coronary heart disease

目的 研究社区综合干预在改善冠心病患者血脂水平及提高患者生命质量中的作用。方法 对 1 5 6例冠心病患者随机分为两组 ,其中社区综合干预组 86例 ,对照组 70例。在两组原药物干预不变且无显著差异的前提下 ,对综合干预组进行定点、定时监测 ,同时进行家庭随访、社区综合干预 ,并与对照组进行前瞻性的对照研究。结果 入组前患者收缩压 (1 5 4 5± 8 6 )mmHg(1mmHg =0 1 33kPa) ,舒张压 (93 3± 5 8)mmHg ,总胆固醇 (6 38± 1 2 5 )mmol/L ,甘油三酯 (1 86±0 86 )mmol/L ,高密度脂蛋白胆固醇 (1 38± 0 81 )mmol/L ,低密度脂蛋白胆固醇 (4 0 2± 1 39)mmol/L。综合干预 2年后 ,患者收缩压 (1 2 9 5± 1 0 3)mmHg ,舒张压 (76 6± 6 9)mmHg ,总胆固醇 (5 2 7± 0 98)mmol/L ,甘油三酯 (1 4 0± 0 1 9)mmol/L ,高密度脂蛋白胆固醇 (2 0 1± 0 6 5 )mmol/L ,低密度脂蛋白胆固醇 (1 6 1± 0 95 )mmol/L ,干预前后比较 ,差异有显著性 (P <0 0 5 ) ,与对照组比较 ,差异有显著性 (P <0 0 5 ) ;2年后综合干预组的并发症、致残率和病死率分别为 3 4 9%、0、1 1 6 %,明显低于对照组的 2 5 71 %、7 1 4 %、5 71 %,二组比较差异有显著性 (P <0 0 0 1 ) ;综合干预组 2年后患者的生命?

Objective To study the effect of comprehensive community intervention on the improvement of bloodlipid profile and quality of life in patients with coronary heart disease (CHD). Methods One hundred and fiftysix cases of CHD patients were randomized into two groups: community intervention group (86 cases) and control group (70 cases). Regular and fixedtime monitoring was carried out and homevisit followup and interventional measures were instituted for the intervention group. There were no changes for existing drug use of the two groups. The results of the two groups were compared prospectively. Results The baseline data of the intervention group were: average systolic blood pressure (SBP) 154.5±8.6 mm Hg, diastolic pressure (DBP) 93.3±5.8 mm Hg, cholesterol (TC) 6.38±1.25 mmol/L, triglyceride (TG) 1.86±0.86 mmol/L, high density lipoprotein cholesterol (HDLC) 1.38±0.81 mmol/L, low density lipoprotein cholesterol (LDLC) 4.02±1.39 mmol/L. After comprehensive intervention for two years, the SBP was 129.5±10.3 mm Hg, DBP was 76.6±6.9 mm Hg, TC was 5.27±0.98 mmol/L, TG was 1.40±0.19 mmol/L, HDLC was 2.01±0.65 mmol/L and LDLC was 1.61±0.95 mmol/L. A significant difference has been observed before and after intervention (P<0.05) in the intervention group. There was also a significant difference between the two groups (P<0.05). The complication rate (3.49%), disablement rate (0) and casefatality rate (1.16%) after twoyears′ intervention in the intervention group were much lower than that of control group (25.71%, 7.14% and 5.71% respectively). The differences were significant statistically (P<0.001). The quality of life, compliance and life satisfaction of patients in the intervention group improved, which were significant compared to the control group (P<0.01). Conclusions Comprehensive community intervention can improve the bloodlipid profile and quality of life of patients suffering from coronary heart disease and should become a new medical modality in the prevention and treatment of coronary heart disease. [