脑梗死并发代谢综合征患者社区干预临床效果评价

Evaluation of clinical effects of community intervention treatment on patients with cerebral infarction combined with metabolic syndrome

目的探讨脑梗死并发代谢综合征(MS)患者社区干预临床效果,为脑梗死并发MS患者的治疗提供依据。方法选择本院门诊2010年10月至2012年10月脑梗死并发MS患者116例,根据患者依从性的不同分组为完全依从组60例和部分依从组56例,进行风险评估后给予社区综合干预治疗,并进行比较。结果与干预前比较,规范化路径干预治疗2年后,完全依从组患者健康知识知晓率(86.7%)、干预计划落实率(88.3%)、三低饮食率(91.7%)均明显提高,急症发生率(3.3%)明显下降,空腹血糖[(6.1±1.3)mmol/L]、餐后2 h血糖[(7.1±2.0)mmol/L]、糖化血红蛋白(6.1%±0.9%)、甘油三酯[(1.4±0.02)mmol/L]、纤维蛋白原[(3.0±0.02)g/L]、血小板最大聚集率(47.3%±0.59%)均明显下降,HDL-C水平[(1.80±0.40)mmol/L]升高,差异均有统计学意义(P<0.05);与部分依从组干预后比较,差异均有统计学意义(P<0.05)。两组干预前颈动脉斑块积分值比较,差异无统计学意义(P>0.05)。完全依从组12、24个月复诊时颈动脉斑块积分低于初诊时,差异有统计学意义(P<0.05),并低于部分依从组,差异有统计学意义(P<0.05)。结论应高度重视脑梗死合并MS患者社区干预,以减少急性脑血管事件的发生率和病死率。

Objective To explore the clinical effects of community intervention treatment on patients with cerebral infarction combined with metabolic syndrome （MS） and to provide the basis for treating the complications of cerebral infarction. Methods A total of 116 cases with cerebral infarction combined with MS during October 2010 and October 2012 were selected. The subjects were divided into compliance group （60 cases） and incomplete compliance group （56 cases）. After community intervention treatment, the risk assessment was performed and compared for two groups. Results After community intervention treatment for 2 years, the health knowledge awareness rate （86.7%）, intervention rate （88.3%） and the rate of reasonable diet （91.7%） significantly increased; the emergency rate （ 3.3 % ） significantly decreased; fasting plasma glucose （FPG） level [ （6.1 1.3 ） mmol/L], 2 h -postprandial plasma glucose （2 h PG） level [（7.1 ＋2.0） mmol/L], glycosylated hemoglobin （HbAc） level （6.1%0.9%）, triglyceride （TG） level [（1.4＋0.02） mmol/L], fibrinogen level [（3.00.02） g/L] and platelet maximum aggregation rate （47.3%0.59%） significantly declined; high-density lipoprotein cholesterol （HDL-C） level [（ 1.800.40） mmol/L] significantly enhanced for compliance group （P〈0.05）. There were significant differences of above indexes between tow groups （P〈0.05）. The carotid plaque integral after intervention treatment for 12 or 24 months in compliance group significantly reduced （P〈0.05）. The carotid plaque integral after intervention treatment for 12 or 24 months in compliance group was significantly lower than that in incomplete compliance group （P〈0.05）. Conclusion The patients with cerebral infarction combined with MS should pay attention to community intervention so as to reduce the morbidity and mortality of acute cerebrovascular disease.