社区缺血性脑卒中患者高血压管理模式的探讨

Exploration of the management model for hypertension of patients with ischemic stroke in Communities

目的通过对社区高血压性脑卒中患者进行强化干预,了解血压控制及再次发生脑卒中事件情况,探讨高血压社区管理模式。方法选取社区卫生服务中心所管辖的六个社区内35岁以上的高血压性脑卒中患者342例,对他们进行高血压社区规范化管理问卷调查和血压测定。并对其中三个社区176例患者(干预组)进行社区强化干预,另外三个社区的166患者(对照组)采取自愿就医方式进行治疗,2年后再次进行问卷调查和血压测定。结果干预2年后,两组低盐饮食率、戒烟率、戒酒率和运动锻炼率较干预前明显增加(P<0.01),而干预组增加更加明显,与对照组比较差异有统计学意义(P<0.01);且干预组高血压知识知晓率、高血压达标率均明显上升,服药率明显升高,与对照组比较差异有统计学意义(P<0.01),干预2年后干预组脑血管事件发生率明显低于对照组,差异有统计学意义(P<0.01)。结论社区强化干预能明显提高脑卒中患者血压控制达标率,降低了再次脑血管事件的发生率,提高了患者生活和生存质量。

Objective To understand hypertension control and recurrence of stroke events through strengthening intervention of patients with hypertensive ischemic stroke in the community, so as to explore the community management model of hypertension. Methods Through issuing questionnaires about standardized management of hypertension in communities and testing blood pressure of patients, we conducted a sample survey of 342 patients of over 35 years old with hypertensive ischemic stroke from six communites within the jurisdiction of the Community Health Service Center.And 176 patients in three of the six communities were given strengthening intervention（the intervention group）, while the 166 patients（the control group） of the other three communities got medical treatment voluntarily.Two years later,all these patients were surveyed by questionnaires and blood pressure tests again.Results After two years of intervention,the low salt diet rate, smoking cessation rate, drinking cessation rate, exercise rate of both groups improved significantly comparing with those before the intervention（ P 〈0.01）.But the intervention group improved more obviously and there were significant statistical differences between two groups （ P〈0.01）.Futbermore, the awareness rate of hypertension knowlege and the success rate of controlling blood pressure of the intervention group significantly increased, while their taking medicine rate increased dramatically, too.There were significant statistical differences comparing with those of the control group（ P 〈0.01）. After two years of intervention, the incidence of ischemic stroke in the intervention group was significantly lower than that of the control group（ P〈0.01 ）. Conclusion Strengthening intervention by community can significantly improve the success rate of blood pressure control of patients with hypertensive ischemic stroke, reduce the incidence of stroke recurrence and improve the quality of life and survival of the patients.