基层医疗机构缺血性脑卒中患者的高血压防治现况

目的 评价北京市城区基层医疗单位就诊的缺血性脑卒中患者高血压防治现况.方法 2004年12月～5年11月在北京市5个区各选一家二级医院.对在上述医院及其所属的社区卫生服务中心(站)就诊的999例缺血性脑卒中患者进行问卷调查,内容包括脑卒中患者的基本情况、现病史、既往史和个人史.结果 999例缺血性脑卒中患者中高血压患病率为79.1%.高血压患者的高血压知晓率、治疗率和控制率分别是93.3%、84.3%和40.3%.高血压患病率随文化程度的升高而降低(P＜0.01);脑卒中发作2次的患者高血压患病率与发作1次的患者比较,差异有统计学意义(P=0.008);伴有心脏病、糖尿病、血脂代谢异常、超重或肥胖的脑卒中患者高血压患病率与无上述因素者比较,差异有统计学意义(P＜0.05).666例接受药物治疗的患者中,45.6%(304例)使用复方类降压药(单用复方类降压药者占47.7%,联合用药者占52.3%);54.4%(362例)使用非复方类降压药(单一用药者占52.2%,联合用药者占47.8%);最常见的组合为钙拮抗剂和β-受体阻滞剂、β-受体阻滞剂和血管紧张素转换酶抑制剂.结论 在北京市基层医疗机构就诊的缺血性脑卒中患者高血压患病率高达79.1%,高血压的控制率还不理想,高血压药物治疗还欠规范,提示基层医疗机构医务人员的高血压防治知识亟待加强与规范.     

微波经内镜灼除消化道息肉100枚体会

我院于1995-08始行微波经内镜灼除消化道息肉62例(100枚)，收到满意效果，现报道如下。     

218例糖尿病患者治疗后血糖未降原因的分析

糖尿病对人类健康的影响正变得日益严重。虽然经过几代人的努力。不断探索其发病原因及治疗方法。但因糖尿病患病率增长速度较快，血糖未得到有效控制的人群不断增加。而使糖尿病慢性并发症日益增多。导致糖尿病的死亡率逐年增加。因此。总结分析糖尿病患者血糖未降原因，进一步探索治疗糖尿病的规律。降低并发症及死亡率是目前急需解决的问题。下面就自1992～2003年218例糖尿病患者血糖未降原因加以分析。     

北京市和平里社区高血压病综合干预效果评价

1996年起北京市东城区和平里社区卫生服务中心参加《北京市1996～2000年健康促进规划》(即卫Ⅶ项目)中有关社区高血压病预防的子项目,在社区采用一系列控制高血压病的综合预防措施,开展健康促进干预活动,取得了一定效果。     

北京社区医护人员脑卒中复发防治知识水平调查

目的 了解北京社区医护人员脑卒中复发防治知识水平.方法 以自填方式,采用自行设计的调查表对119名服务于北京社区卫生服务中心(站)的社区医护人员进行调查,了解他们对脑卒中复发防治知识的掌握情况.结果 61.40%的社区医师和35.71%的社区护士认为自己具有管理脑卒中患者的能力.按百分制计算,被调查的社区医护人员脑卒中复发防治相关知识总分为41分;社区医师知识总分(42分)高于社区护士的知识总分(38分).结论 北京社区医护人员尚不完全具备系统管理脑卒中患者的能力,他们的脑卒中复发防治知识水平有待进一步提高.     

社区卫生服务机构就诊的缺血性脑卒中患者抑郁患病率及影响因素

目的 调查社区卒中患者卒中后抑郁(PSD)的患病率及其相关影响因素. 方法在北京市城区选择五家二级医院所属社区卫生服务中心,登记2003年1月至2006年12就诊的缺血性脑卒中患者.采用抑郁自评量表(SDS)评价脑卒中患者PSD患病情况,同时还收集了脑卒中起病情况、脑卒中危险因素等资料. 结果共登记1089例脑卒中患者,其中1074例符合入选标准并有完整资料,平均年龄(65.0±8.9)岁,脑卒中病程中位数为13.0个月.PSD总患病率为49.9%(536/1074),其中轻、中、重度PSD分别占52.2%、36.0%和11.8%.不同脑卒中病程的PSD患病率差别不大,脑卒中后6个月内、7～18个月、18个月以上的PSD患病率分别是51.3%、47.1%和53.2%.PSD患病与文化程度、日常生活依赖、认知功能情况、脑卒中发作次数、文化程度独立相关. 结论在社区卫生服务机构就诊的缺血性脑卒中患者中有较高的PSD患病率,但是以轻中度为主,积极采取有效的早期干预,可以有效控制PSD的发生和发展,促进患者神经功能的康复,改善预后,提高生活质量.

Abstract：

Objective To estimate the prevalence and related risk factors of post-stroke depression (PSD) in ischemic stroke survivors from community-based medical centers in urban areas of Beijing.Methods Five community-based medical centers in urban areas of Beijing were selected.Patients with first-ever or recurrent ischemic stroke were evaluated from January 2003 to December 2006. The prevalence of PSD was evaluated by Self-Rating Depression Scale (SDS), and the information on the onset of stroke, vascular risk factors and living style was also collected.Results Totally 1089 stroke patients were registered, 1074 cases among which had complete information and met inclusion criteria. The mean age of the patients was (65.0 ± 8.9) years with a median stroke course of 13.0 months. The overall prevalence of PSD was 49.9% (536/1074), and the proportions of mild, moderate and major PSD were 52.2%, 36.0% and 11.8%, respectively. There were no significant differences in prevalence of PSD among different stages of stroke and the prevalence of PSD was 51.3% within 6 months after stroke onset, 47. 1% during 6-18 months and 53.2% after 18months. Low education, activities of Daily Living (ADL) dependence, cognition impairment and recurrence of stroke were independent risk factors for PSD.Conclusions The prevalence of PSD among ischemic stroke patients is higher in community-based medical centers, but most of PSD patients are mild or moderate. More effective early intervention should be adopted to decrease PSD,promote the recovery of neural function and improve their quality of life.     

和平里社区慢性非传染性疾病预防的过程评价

目的 对和平里社区慢性病预防效果进行评估。方法 采用社会学和流行病学调查的方法对现有的文字资料和居民行为危险因素、人文环境及卫生服务政策等进行分析。结果 社区形成了健康促进的支持环境、工作模式和工作网络，慢性病防治工作得到了各级政府的重视。结论 还需强化基层医务人员的培训、居民健康教育及信息化建设工作。     

常规导联心电图诊断右心室梗死的临床价值

右室梗死在急性下壁心肌梗死（以下称心梗）中可占１９％￣５１％，其重要并发症及病死率均明显高于单纯下壁心梗者。本文通过３５例急性下壁心肌梗死住院患者的常规心电图测量、分析、统计学处理，就基层医院无高新诊断技术设备的情况下常规导联心电图对急性下壁心梗合并右室梗死的临床诊断价值进行初步探讨，提出ＳＴ升高Ⅲ／Ⅱ〉１可作为急性下壁心梗时合并右室梗死的诊断依据之一；ＳＴ降低Ｖ２／ＳＴ升高ａＶＦ≤５０％可作为重     

代谢综合征在缺血性卒中患者心脑血管事件发生中的作用

Objective To explore the association between metabolic syndrome (MS) and risk of cardiovascular disease events (CVD) in patients with ischemic stroke. Method A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jar. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRus and 95% CI of CVD events associated with MS and other components. Results The prevalence of MS was 40. 4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking,drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration,depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% (HR:1.44, 95%CI:1.06-1.95 ). The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% (HR:1. 30,95%CI:0.83-2.04) in those with 2 components and by 69% ( HR: 1.69,95% CI: 1.11-2.56) in those with 3or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event ( all P ＜ 0. 001 ) . Conclusions MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.