中医全科慢性病管理模式对痛风伴高尿酸血症老年患者的效果分析

Analysis of effect of general practice of traditional Chinese in managing chronic disease on elderly gout patients with hyperuricemia

目的研究中医全科慢性病管理模式(TCM-CDGP)对痛风伴高尿酸血症老年患者的作用。方法选取2018年3月至2019年3月沙河街、沙东街社区卫生服务中心社区痛风伴高尿酸血症患者124例,按随机数字表将患者分为对照组与观察组,每组62例。对照组给予常规膳食指导与宣教随访,间歇期予别嘌醇治疗,急性期予塞来昔布治疗。而观察组给予TCM-CDGP干预,间歇期不予药物治疗,急性期予塞来昔布减量治疗。两组患者均连续观察1年。观察两组患者干预前后的症状和体征、急性期发作次数与专科就诊次数、干预前后健康调查简表(SF-36)与匹兹堡睡眠质量量表(PSQI)的改善情况以及干预前后的血清尿酸含量水平。结果观察组总有效率为93.55%,对照组总有效率为77.42%,观察组总有效率高于对照组(P<0.05)。观察组干预后血尿酸水平明显低于对照组(P<0.05),急性期发作次数与专科就诊次数均明显少于对照组(P<0.01),干预后SF-36明显高于对照组(P<0.05),PSQI明显低于对照组(P<0.01)。结论 TCM-CDGP能够改善患者的临床症状与生活质量,还可减少急性发作次数与专科就诊次数,作用可能与降低患者血尿酸水平有关。

Objective To investigate the effect of general practice of traditional Chinese in managing chronic disease(TCM-CDGP) on elderly gout patients with hyperuricemia.Methods 124 elderly gout patients with hyperuricemia in Health Service Center of Shadong Street Community and Health Service Center of Shahe Street Community from March 2018 to March 2019 were selected.The patients were randomly divided into control group and observation group,with 62 cases in each group.The control group were given routine dietary guidance,education follow-up,allopurinol treatment in intermittent period and celecoxib treatment in acute period.The observation group were given TCM-CDGP intervention,no drugs were provided in intermittent period,while low-dose celecoxib was given in the acute period.Both groups were observed continuously for 1 year.The symptoms and signs of the two groups were observed before and after intervention.The times of acute attacks and specialist visits,the improvement of SF-36 and PSQI as well as the levels of serum uric acid before and after intervention were observed in both groups.Results The total effective rate was 93.55% in the observation group,which was higher than that(77.42%) in the control group(P<0.05).After intervention,the level of serum uric acid in the observation group was significantly lower than that in the control group(P<0.05),the times of acute attack and specialist visit were significantly less than those in the control group(P<0.01),SF-36 was significantly higher than that in the control group(P<0.05),and PSQI was significantly lower than that in the control group(P<0.01).Conclusion TCM-CDGP can improve the clinical symptoms and quality of life of gout patients with hyperuricemia,and reduce the number of acute attacks and specialist visits,the effect may be related to the reduction of serum uric acid.