上海地区社区与三级医院的缺血性卒中患者的危险因素比较

Risk factors of ischemic stroke:a comparison between community hospitals and three-A hospitals in Shanghai

目的探讨分别在上海地区社区卫生服务中心和三级医院就诊的缺血性脑卒中患者的危险因素分布特点。方法在上海地区1所三级教学医院(三级医院组)和7个社区卫生服务中心(社区卫生服务中心组)设立脑卒中二级预防门诊,收集连续就诊的资料完整的缺血性脑卒中患者1770例,记录其人口学资料、血管性危险因素及不良生活方式,分析各个危险因素的百分比、危险因素的累积数目及危险因素组合。结果社区卫生服务中心组高血压、糖尿病、心脏疾病和脑卒中患者的构成比均显著高于三级医院组(P值均<0.01),而血脂异常、吸烟、饮酒、缺乏锻炼患者的构成比则显著降低(P值均<0.01)。三级医院组患者中伴有多个危险因素的构成比显著高于社区卫生服务中心组(P<0.01),高血压伴糖尿病患者的比例显著降低(P<0.01)。结论在缺血性脑卒中二级预防的工作中,要加强危险因素的筛查,对在社区卫生服务中心就诊的患者需要给予积极的危险因素有效药物控制,而对在三级医院就诊的患者则应重视生活方式的干预。

Objective To investigate the risk factor distributions in ischemic stroke patients of community hospitals and three-A hospitals. Methods The demographic characteristics, cardiovascular risk factors, and unhealthy life styles of 1 770 consecutive patients with ischemic stroke were investigated in the stroke clinics in Shanghai Renji Hospital （a three-A hospital of large scale） and 7 community health service centers in Shanghai Pudong and Putuo districts. The prevalence of each risk factor was calculated; the cumulative number and combination of risk factors were also assessed. Results The prevalences of hypertension, diabetes, heart disease and stroke histories were significantly higher in the community hospital patients （all P0.01） than those in Ruijin Hospital. The prevalences of hyperlipidemia, smoke, alcohol drinking and lack of exercise were significantly higher in patients from Ruijin Hospital compared with those from the community hospitals （all P0.01）; patients from the Ruijin Hospital were more liable to have multiple risk factors （P0.001）. However, the combination of hypertension with diabetes was more prevalent in community hospital patients （P0.001）. Conclusion For secondary prevention of ischemic stroke, the screening of risk factors should be strengthened. Community hospital patients should be strictly treated to control the vascular risk factors, while the patients from three-A hospitals should be given more education to improve their lifestyle.