个体化健康教育对伴颈动脉斑块形成的社区“三高”患者的干预效果

Intervention of individualized health education on community “three high” patients with carotid plaque formation

目的:探讨个体化健康教育对社区"三高"患者的血压、血糖、血脂及颈动脉粥样硬化的干预效果。方法:收集2007年5月至2009年1月同时患有"三高"且经彩超证实患有颈动脉斑块形成的患者118例,随机分为个体化组(最终56例)及传统组(最终57例)。个体化组对患者先进行系统的健康教育,再进行个体化健康教育;传统组只进行系统的健康教育,持续随访1年。比较两组治疗依从性、血压(SBP和DBP)、TC、LDL、HBAlC、颈动脉IMT和斑块积分(Crouse score)的干预效果。结果:个体化组干预后患者的服药、饮食、戒烟和限酒依从性、SBP、DBP、TC、LDL、HBAlC及IMT均有改善(P<0.01或P<0.05),Crouse score无统计学差异。传统组服药及戒烟依从性、SBP和HBA1C水平有改善(P<0.01或P<0.05),Crouse score有增长趋势,IMT有进展(P<0.01);个体化组对"三高"因素及IMT的干预效果好于传统组(P<0.01),Crouse score无统计学差异。结论:个体化健康教育可以通过改善患者的生活方式和治疗依从性,更好的控制"三高"水平,从而延缓颈动脉粥样硬化的进展。

Objective To investigate the intervention effects of individualized health education on the blood pressure, blood sugar, blood lipids and carotid sclerosis of community ＂three high＂ patients. Methods From May 2007 to January 2010, 118 ＂three high＂ outpatients were diagnosed with carotid plaque formation by carotid color ultrasound. They were randomly divided into individualized （finally, 56 cases） and traditional （finally, 57 cases） health education group, and the systemic followed by individualized health education was given to individualized group, while only systemic health education was given to traditional group; the follow-up continued for 1 year. The comparisons of treatment compliance, systolic and diastolic blood pressure （SBP and DBP）, total cholesterol （TC）, low density lipoprotein （LDL） and glycosylated hemoglobin （HBA1C）, carotid intima-media thickness （IMT） and Crouse score of carotid plaques were performed within and between 2 groups. Results By comparison within group, significant intervention effects of the compliances of taking medicine, diet, smoking cessation and limit alcohol, SBP, DBP, TC, LDL, HBAIC and IMT in individualized group （56 cases） were found （P〈 0.01 or P 〈 0.05）, but no significant difference on Course score; in traditional group （57 cases）, the compliances of taking medicine and smoking cessation, SBP and HBAIC also exhibited significant improvements （P 〈 0.01 or P 〈 0.05）, and the Course score showed an increasing tendency, while the IMT increased （P 〈 0.01 ）. By comparison between groups, better intervention effects on ＂three high＂ factors and IMT were identified in individualized group compared with traditional group （P 〈 0.01 ）, while no significant difference on Course score. Conclusions Individualized health education are more helpful to control the ＂three high＂ level and further delay the carotid atherosclerosis progress by improving the patients＇ life style and treatment compliances.