医联体模式下综合干预对颈动脉粥样硬化患者的效果

Effect of comprehensive intervention under medical union mode on patients with carotid atherosclerosis

目的:探讨医联体模式下综合干预对颈动脉粥样硬化(CAS)患者的效果。方法:选择符合入选标准的572例CAS患者进行为期2年的社区综合干预研究。干预前后记录比较患者对CAS危险因素(包括高血压、糖尿病、高脂血症等)的认知率,健康行为(包括规律运动、定期测量血压、血糖、血脂等)形成率,颈动脉内-中膜厚度(IMT),Crouse斑块积分,不稳定斑块比例,血糖、血压、血脂指标,高敏C反应蛋白(hsCRP)、血尿酸(SUA)及人体质量指数(BMI)。结果:随访:2年后失访、死亡31例(5.42%),尚存541例。与干预前比较,干预后患者的CAS危险因素认知率和健康行为形成率均显著升高,颈动脉IMT[(1.82±0.30)mm比(1.60±0.19)mm]、Crouse斑块积分[(5.56±1.62)分比(4.40±1.04)分]和不稳定斑块比例(62.68%比49.02%)均显著减小,P均=0.001;FPG、HbA1c、TG、TC、LDL-C、hsCRP、SUA、血压及BMI显著减小,HDL-C水平显著升高,P均=0.001。结论:在医联体模式下,积极社区综合干预对颈动脉粥样硬化的效果显著,具有重要示范和推广意义。

Objective:To explore effect of comprehensive intervention under medical union mode on patients with carotid atherosclerosis (CAS). Methods:A total of 572 CAS patients were enrolled, and they received two-year community comprehensive intervention. Cognitive rates for CAS risk factors (hypertension, diabetes mellitus, hyperlipidemia etc.), formation rates of healthy behavior (regular exercise, regular measurements of blood glucose, blood pressure, blood lipids etc.), carotid intima-media thickness (IMT), Crouse plaque score, percentage of unstable plaques, levels of blood pressure, blood glucose, blood lipids, high sensitivity C reactive protein (hsCRP), serum uric acid (SUA) and body mass index (BMI) were recorded and compared between before and after intervention. Results:After two-year follow-up, a total of 31 cases (5.42%) died or were lost, and 541 cases remained. Compared with before intervention, after intervention, there were significant rise in cognitive rates for CAS risk factors and formation rates of healthy behavior, and significant reductions in carotid IMT [(1.82±0.30)mm vs.(1.60±0.19)mm], Crouse plaque score [(5.56±1.62) scores vs.(4.40±1.04) scores]and percentage of unstable plaques (62.68% vs. 49.02%), P =0.001 all;significant reductions in levels of FPG, HbA1c, TG, TC, LDL-C, hsCRP, SUA, blood pressure and BMI, and significant rise in HDL-C level, P =0.001 all. Conclusion:Under medical union mode, active community comprehensive intervention possesses significant effect, and promotion meaning.