疾病细节管理在社区高尿酸血症管理中的应用效果分析

Detailed disease management model in community management of hyperuricemic patients

目的探讨疾病细节管理在社区高尿酸血症管理中的应用效果，为探讨建立规范化的社区高尿酸血症管理模式提供科学依据。方法2012年4—6月纳入150例确诊为原发性高尿酸血症患者，随机分为2组：细节管理组和门诊常规组，分别实施1年的疾病细节管理和门诊常规管理，并在管理前后进行问卷调查及身高、体质量及血尿酸等生化指标检测，比较两组管理前后各生化指标、疾病知晓情况、行为模式包括吸烟、饮酒、和饮食情况、规范治疗率、治疗满意率情况等，然后检验管理前后的差异性，评价随访后的效果。结果136例患者完成随访，其中细节管理组68例，门诊常规组68例。管理1年后，细节管理组患者血尿酸、TG、LDL—C均低于管理前基线水平，差异有统计学意义（均P〈0．01）；而常规组管理前后血尿酸和血脂水平差异无统计学意义（均P〉0．05）。与管理前比较，管理1年后细节管理组疾病知晓问卷评分由（65．4±5．4）分提高至（82．7±4．2）分（Z=-10．2，P〈0．01），高嘌呤饮食率从47．1％下降至7．4％（X^2=33．6，P〈0．01），规范治疗率由10．3％升高至85．3％（X^2=76．6，P〈0．01），治疗满意率从51．5％提高到88．2％（X^2=21．8，P〈0．01）；细节管理组患者管理后血尿酸（Z=-7．4，P〈0．01）、TC（Z=-0．01，P〈0．01）、TG（Z=-2．4，P〈0．01）、LDL-C（Z=-3．2，P=0．03）、高嘌呤饮食率（X^2=27．1，P〈0．叭）均低于门诊常规组，规范治疗率高于门诊常规组（X^2=70．6，P〈0．01），治疗满意度高于门诊常规组（X^2=5．6，P=0．02）。结论疾病细节管理在社区高尿酸血症管理中具有良好的应用效果，可以作为社区规范化高尿酸血症管理有效方式之一。

Objective To evaluate the effect of detailed disease management model in community management of hyperuricemic patients. Methods One hundred and fifty patients with primary hyperuricemia were randomly divided into detailed management group and conventional group from April to June 2012, patients in two groups were managed by different models for 1 year. The weight, height, biochemical indexes including blood uric acid and serum lipids were measured and a questionnaire survey was conducted with the items of disease awareness score, smoking, drinking, diet, standard treatment, satisfaction of treatment etc. before and after management. Results One hundred and thirty six patients completed the study including 68 in detailed management group and 68 in conventional group. After one year management, the blood uric acid, triglyceride, low density lipoprotein （all P 〈 0. 01 ） were statistically lower than baseline in detailed management group, while there were no statistical differences of these indexes in conventional group （P 〉 0.05）.The disease awareness score increased from （65.4±5.4） to （82.7 ±4.2） （Z= - 10.2, P 〈 0. 01 ） , high purine diet rate fell from 47.1% to 7.4% （X2 = 33.6, P 〈 0. 01 ） , the standard treatment rates increased from 10. 3% to 85.3% （X2 =76. 6, P 〈0. 01 ） , treatment satisfaction rate increased from 51.5% to 88.2% （X2 =21.8, P 〈0. 01 ） in detailed management group. In detailed management group, the blood uric acid （Z = -7.4, P 〈 0. 01）, total cholesterol （Z = - 0. 01, P 〈0. 01 ） , triglyceride （Z = - 2. 4, P 〈 0.01 ） and low density lipoprotein （ Z = - 3.2, P = 0. 03 ） and high purine diet rate were lower （X2 =27. I, P 〈0. 01 ）, the standard treatment rate （X2 =70. 6, P 〈0. 01 ） and treatment satisfaction rate were higher （X2 = 5.6, P = 0. 02） than those in conventional group after 1 year management. Conclusion Detailed disease management is an applicable and effective model for community management of hyperuricemic