上海市脑卒中社区人群计划防治研究

Community-based Preventive Program of Stroke in Shanghai

目的 了解已证明有效的干预措施在社区实施的效果以及需要的人力和费用如何 ,从而总结出符合中国国情的脑卒中防治方案。方法 对上海 8个社区 38 3万人口进行以社区为基础的脑卒中综合防治研究 ,干预措施包括高血压控制、糖尿病控制和合理营养。结果 通过 2年的干预 ,全人群高血压知晓率为 80 6 % ;高血压病人管理率达6 6 % ,血压值 <16 0 / 95mmHg的控制率为 6 1% ,血压值 <14 0 / 90mmHg的控制率为 31% ;2年里高血压人群收缩压下降 3 9mmHg ,舒张压下降 1 8mmHg。干预人群脑卒中标化发病率较干预前下降 4 2 2 4 / 10万。以 5个设有对照的社区来分析 ,扣除了对照的基数后 ,2年来脑卒中发病减少 70例 ,平均每年脑卒中发病减少 2 5 4 1/ 10万。经济学分析表明 8个干预点用于高血压防治预防脑卒中所花费用平均为 38 0元 /人·年 ,平均每位卫生工作人员应管高血压病人数为 4 5 9人。研究也发现在高血压和脑卒中的第一级预防、对三级高血压病人的管理和对上班人员高血压的防治方面仍是薄弱环节。结论 脑卒中的社区综合防治是有效的 ,但需要进一步加强高血压的第一级预防和对轻度高血压尤其是上班族高血压的管理 ,研究提出了脑卒中社区防治

Objective To evaluate effectiveness of community-based preventive program of stroke in large scale population through interventions with high efficacy.Methods Eight communities with 383 thousands of population were selected for interventions,which included hypertension management,balance nutrition,smoking control and diabetes management.Results After 2-year interventions,the rates of awaeness,management and control(<140/90mmHg) of hypertension were 80 6%,66.1% and 30.5% respectively.The levels of blood pressure among hypertensives were reduced by 3.9mmHg for systolic blood pressure and 1.8mmHg for diastolic blood pressure.The standardized mortality of stroke was reduced by 25.4/100 000 per year.The economic analysis showed that cost for management of hypertensives was 38 yuan/person·year,and that each health worker could manage about 459 hypertensives.Conclusion The evaluation of the present study also indicated that there was good effectivness of stroke community-based prevention but it was needed to strengthen primary prevention of hypertension,management of hypertensives and management of hypertensives who were employed.Four key strategies for the community-based prevention of stroke were suggested.