某社区老年人群卒中一级干预方案实施效果的初步评价

目的 初步评价某社区老年人群卒中一级干预方案的实施效果.方法 选择上海市奉贤区某社区2019年参加社区老年健康体检并于2021年再次参加健康体检的老年人群作为研究对象.纳入社区人群的年龄≥60岁.以社区卫生服务中心为依托,以社区老年人年度健康体检结果为数据来源.在体检过程中进行一般情况调查,并进行卒中风险评估、卒中高危...

Preliminary evaluation of the effect of primary stroke prevention program in community elderly population

Objective To evaluate the effect of primary stroke prevention program in a community elderly population.Methods The elderly population in a community in Fengxian District of Shanghai who participated in the community health physical examination for the elderly in 2019 and again in 2021 were selected as the research objects.The age of the population recruited in the community is≥60 years.Based on the community health service center,the annual physical examination results of the elderly in the community were used as data sources.A general investigation was conducted during the examination.The prevention program also included screening high-risk population of stroke during physical examination,first-visit intervention combined with risk assessment results,and long-term intervention management for high-risk individuals.The risk assessment index of stroke was cerebrovascular function score,and 75-100 points were non high risk,50-<75 points were mild risk,25-<50 points were moderate risk,and 0-<25 points were severe risk.After 2 years intervention,combined with physical examination,the cerebrovascular function was re-examined,and the changes of cerebrovascular function score,blood pressure,height,body weight,blood lipid,blood glucose and glycosylated hemoglobin A1c were compared before and after intervention.Results(1)A total of 2333 patients completed the 2019 screening and 2021 reexamination,including 1039 males and 1294 females.(2)Compared with the results of the initial screening in 2019,the proportion of systolic(<140,140-159 and≥160 mmHg)and diastolic blood pressure levels(<90,90-99 and≥100 mmHg)increased in males and diastolic blood pressure levels(<90,90-99 and≥100 mmHg)increased in females in 2021 were significantly lower,with statistically significant differences before and after intervention(58.5%608/1039],31.7%329/1039],9.8%102/1039]vs.54.1%562/1039],32.5%338/1039],13.4%139/1039],respectively,χ²=7.610,P=0.022;78.4%815/1039],16.8%175/1039],4.7%49/1039]vs.65.2%677/1039],24.7%257/1039],10.1%105/1039],respectively,χ²=48.693,P<0.01;76.7%993/1294],18.9%245/1294],4.3%56/1294]vs.68.2%883/1294],23.6%306/1294],8.1%105/1294],respectively,χ²=28.166,P<0.01).However,there was no statistical significance in systolic blood pressure of healthy females before and after intervention(P>0.05).(3)Compared with screening results at the beginning of 2019,triacylglycerol and low-density lipoprotein decreased,and fasting glucose levels increased in males and females in 2021,with statistically significant differences(males:1.150.81,1.62]mmol/L vs.1.200.85,1.76]mmol/L,Z=-3.983 mmol/L;2.44±0.65]mmol/L vs.2.66±0.70]mmol/L,t=-14.800;4.94.5,5.6]mmol/L vs.4.84.4,5.4]mmol/L,Z=5.180;females:1.391.01,1.99]mmol/L vs.1.441.03,1.98]mmol/L,Z=-2.593;2.67±0.68]mmol/L vs.2.96±0.74]mmol/L,t=-18.788;5.04.6,5.6]mmol/L vs.4.94.5,5.5]mmol/L,Z=2.258;all P<0.05).There were no significant differences in total cholesterol and glycosylated hemoglobin A1c between males and females(all P>0.05).(4)Before and after intervention,the distribution of cerebral vascular function score changed significantly(χ²=11.351,P=0.010),the proportion of moderate(in 2019 and 2021,it was 15.0%350 cases]and 13.2%308 cases]respectively)and severe risk(in 2019 and 2021,it was 9.9%231 cases]and 7.8%183 cases]respectively)decreased,the proportion of non-high risk(in 2019 and 2021,it was 58.9%1374 cases]and 60.9%1421 cases]respectively)and mild risk(in 2019 and 2021,it was 16.2%378 cases]and 18.0%421 cases]respectively)increased.Conclusion The preliminary analysis of the health examination results of the elderly in a community showed that the primary stroke prevention program in the population with high-risk of stroke had a certain effect on reducing the exposure level of blood pressure,blood lipid and other risk factors,and the risk level of stroke has decreased.