基于治疗性生活方式改变的不同健康教育模式在血脂异常人群中应用的效果

Effects of health education using therapeutic lifestyle changes method in a population with dyslipidemia

目的探讨基于治疗性生活方式改变的不同健康教育模式在血脂异常人群中实施的效果。方法纳入福建省立医院2014年9月至2015年3月于门诊诊断为血脂异常的病例，采用简单随机分组法将患者随机分为4组，常规组提供门诊咨询服务；课程组参加6次健康教育讲座；电话组安排每月2次的电话跟踪随访；综合组同时给予课程组和电话组的干预，同时对4组开展24周连续干预。分别比较干预前、干预24周各组内及组间总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）和高密度脂蛋白胆固醇（HDL-C）的变化及血脂知识、患者态度、行为（KAP）得分情况。结果共纳入并配合完成本研究214例（常规组62例，课程组49例，电话组56例，综合组47例）。组内比较，干预后24周，课程组[血脂值以TC为例：TC=（5.14±0.87）mmol/L，KAP=（42.96±5.72）分]、电话组[TC=（5.22±1.07）mmol/L，KAP=（39.41±5.03）分]及综合组[TC=（4.00±0.79）mmol/L，KAP=（45.05±3.19）分]的血脂值及知信行得分较干预前[课程组：TC=（5.74±0.69）mmol/L，KAP=（35.22±1.67）分；电话组：TC=（5.63±0.58）mmol/L，KAP=（34.54.±0.97）分；综合组：TC=（5.60±0.48）mmol/L，KAP=（35.44±1.80）分]均有明显的改善（P〈0.05），而常规组干预后[TC=（5.32±1.28）mmol/L，KAP=（35.28±4.02）分]相比干预前[TC=（5.66±0.54）mmol/L，KAP=（34.37±0.65）分]，其差异无统计学意义（P〉0.05）。组间比较，电话组、课程组干预24周血脂值和KAP得分都优于常规组，而综合组干预24周血脂改善情况及KAP得分皆优于其他3组（P均〈0.05）。结论课程结合电话随访的综合健康教育模式相比单一一种方式对改善血脂状况及提高患者血脂健康意识的效果更明显。这种叠加式的健康教育模式不仅能在一定程度上的获得治疗效果，同时在开展过程中其监督和管理的作用也是保证医疗卫生机构实行延续性护理服务的必要方法和措施。

ObjectiveThis study evaluated the effects of health education promoting therapeutic lifestyle changes in a population with dyslipidemia.MethodsPatients with dyslipidemia were randomly assigned to one of four groups： the current group （CG） received conventional health guidance, the educational course （EC） group attended six lectures as part of an educational course, the phone call （PC） group received twice-monthly follow-up by telephone, and the comprehensive group （EC ＋ PC） attended both the educational course and received follow-up telephone calls. Total cholesterol （TC）, total triglycerides （TG）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein （HDL-C）, and the knowledge, attitude, and behavior （KAP） score for blood lipids were compared within each group and among groups.ResultsA total of 214 patients were enrolled and completed the study： 62 patients in CG, 49 patients in EC, 56 patients in PC, and 47 patients in EC ＋ PC. There were significant differences in the EC, PC, and EC ＋ PC groups after the 24-week intervention. For example, pre- and post-intervention values for each group were as follows： EC group： （5.74±0.69） mmol/L and （5.14±0.87） mmol/L for TC, 35.22±1.67 and 42.96±5.72 for KAP; PC group： （5.63±0.58） mmol/L and （5.22±1.07） mmol/L for TC, 34.54.±0.97and 39.41±5.03 for KAP; EC ＋ PC group： （5.60±0.48） mmol/L and （4.00±0.79） mmol/L for TC, 35.44±1.80 and 45.05±3.19 for KAP, respectively （P〈0.05）. The CG group showed no significant differences before and after treatment： （5.66±0.54） vs. （5.32±1.28） mmol/L for TC, 34.37±0.65 vs. 35.28±4.02 for KAP （P〉 0.05）. In a comparison among the four groups, the EC and PC groups showed greater improvements than the CG group. Moreover, the EC ＋ PC group showed statistically significant differences in the results compared with the other three groups （P〈 0.05）.ConclusionAn educational course combined with telephone follow-up calls was more effective than a single intervention in improving blood lipids and enhancing the health awareness of patients with dyslipidemia. This combined health education model not only improves the effectiveness of treatment to some degree, but also plays a role in its supervision and management. Furthermore, it may also assist in the implementation of continuous nursing services in medical institutions.