CAJ | 학술논문

背景:已经有诸多大样本实验说明针对心脑血管疾病的危险因素进行社区综合防治可降低其发病率和死亡率,但对干预的过程评价和效果评价有待于更多的样本证实.目的:了解心脑血管疾病综合防治措施在社区实施的效果以及所需的卫生成本,总结适合农村社区心脑血管疾病综合防治的工作模式.设计:以社区正常人群为研究对象,社区干预试验.单位:广东省中山市古镇人民医院社区卫生服务科,广州医学院神经科学研究所.对象:选择1992-03/2002-03广东省中山市古镇中心8个村20～74岁常住居民共3.2万人,男1.46万人,女1.74万人.方法:进行以社区为基础的心脑血管疾病综合防治干预,内容包括高血压管理、控烟、合理营养、全民健身运动及糖尿病管理等.主要观察指标:[1]全人群心脑血管疾病相关的知识、态度及行为水平.[2]高血压管理率和控制率.[3]脑卒中的发病率和死亡率.结果:[1]通过10年的干预,全人群血压知晓率为70.29%.[2]高血压管理率和控制率逐年提高,其中管理率由1997年的25.66%上升到2002年的80.50%,总控制率由1997年的4.43%上升到2002年的45.80%,而血压＜160/95 mm Hg(1 mm Hg=0.133 kPa)控制率为58.80%,血压＜140/90 mm Hg控制率为32.80%.[3]干预点社区人群收缩压和舒张压水平均下降,其差值分别为7.23 mm Hg和3.92 mm Hg.[4]全人群心脑血管疾病相关知识、态度及行为水平明显提高.[5]全人群脑卒中发病率和死亡率呈逐年下降趋势,分别由1997年的146.90/10万和108.63/10万下降到2002年的105.83/10万和69.90/10万,6年来分别减少了41.07/10万和38.73/10万,且发病年龄后移.[6]经济学分析表明,1997/2001的平均效益-成本比为2.32.结论:以社区为基础的心脑血管疾病综合防治措施能提高社区人群心脑血管疾病相关知识、态度及行为水平,并能降低脑卒中的发病率和死亡率.
배경:이경유제다대양본실험설명침대심뇌혈관질병적위험인소진행사구종합방치가강저기발병솔화사망솔,단대간예적과정평개화효과평개유대우경다적양본증실.목적:료해심뇌혈관질병종합방치조시재사구실시적효과이급소수적위생성본,총결괄합농촌사구심뇌혈관질병종합방치적공작모식.설계:이사구정상인군위연구대상,사구간예시험.단위:광동성중산시고진인민의원사구위생복무과,엄주의학원신경과학연구소.대상:선택1992-03/2002-03광동성중산시고진중심8개촌20～74세상주거민공3.2만인,남1.46만인,녀1.74만인.방법:진행이사구위기출적심뇌혈관질병종합방치간예,내용포괄고혈압관리、공연、합리영양、전민건신운동급당뇨병관리등.주요관찰지표:[1]전인군심뇌혈관질병상관적지식、태도급행위수평.[2]고혈압관리솔화공제솔.[3]뇌졸중적발병솔화사망솔.결과:[1]통과10년적간예,전인군혈압지효솔위70.29%.[2]고혈압관리솔화공제솔축년제고,기중관리솔유1997년적25.66%상승도2002년적80.50%,총공제솔유1997년적4.43%상승도2002년적45.80%,이혈압＜160/95 mm Hg(1 mm Hg=0.133 kPa)공제솔위58.80%,혈압＜140/90 mm Hg공제솔위32.80%.[3]간예점사구인군수축압화서장압수평균하강,기차치분별위7.23 mm Hg화3.92 mm Hg.[4]전인군심뇌혈관질병상관지식、태도급행위수평명현제고.[5]전인군뇌졸중발병솔화사망솔정축년하강추세,분별유1997년적146.90/10만화108.63/10만하강도2002년적105.83/10만화69.90/10만,6년래분별감소료41.07/10만화38.73/10만,차발병년령후이.[6]경제학분석표명,1997/2001적평균효익-성본비위2.32.결론:이사구위기출적심뇌혈관질병종합방치조시능제고사구인군심뇌혈관질병상관지식、태도급행위수평,병능강저뇌졸중적발병솔화사망솔.
BACKGROUND: It has been explained in many big sample experiments that community comprehensive prevention from the risks of cardiocerebrovascular disease can reduce its morbidity and mortality. But, it is required more samples to verify the evaluations of the process and effect of intervention.OBJECTIVE: To understand the effect of community comprehensive prevention on cardiocerebrovascular disease and hygienic costs demanded and summarizes the suitable patterns of comprehensive prevention on cardiocerebrovascular disease in countryside.DESIGN: Healthy people in community were taken as the objects and community intervention was designed.SETTING: Department of Community Hygienic Service of People's Hospital in Guzheng Town, Zhongshan City, Guangdong Province and Neurological Institute of Guangzhou Medical College.PARTICIPANTS: Totally 32 000 inhabitants were collected from 8 villages in Guzheng Town, Zhongshan City, Guangdong Province from March 1992 to March 2002, aged varied from 20 to 74 years, of which, 14 600inhabitants were male and 17 400 inhabitants were female.METHODS: The intervention of community-based prevention was applied on cardiocerebrovascular disease, including managementof hypertension,smoking control, rational nutrient, nationwide body building and diabetic management.MAIN OUTCOME MEASURES: [1] Awareness, attitude and behavior related to cardiocerebrovascular disease. [2] Management rate and control rate of hypertension. [3] Morbidity and mortality of cerebral apoplexy.RESULTS: [1] By 10-year intervention, awareness rate of hypertension in whole group was 70.29%. [2] Management rate and control rate of hypertension were increased yearly, in which, the management rate was increased from 25.66% in 1997 to 80.50% in 2002, the total control rate was increased from 4.43% in 1997 to 45.80% in 2002, the control rate of blood pressure ＜160/95 mm HG (1 mm Hg=0.133 kPa) was 58.80%and that ＜140/90 mm Hg was 32.80%. [3] The systolic and diastolic pressures in intervention community were decreased averagely, in which the D-values are 7.23 mm Hg and 3.92 mm Hg respectively. [4] The awareness, attitude and behavior related to cardiocerebrovascular disease were enhanced remarkably. [5] Morbidity and mortality of cerebral apoplexy were in tendency of decreasing yearly, from 146.90/100 000 and 108.63/100 000 in 1997 to 105.83/100 000 and 69.90/100 000 in 2002 respectively, by 41.07/100 000 and 38.73/100 000 respectively in 6 years and the age of incidence was postponed. [6] It was indicated in economic analysis that the average ratio of profit to cost between 1997 and 2001 was 2.32.CONCLUSION: Community-based comprehensive prevention on cardiocerebrovascular disease improves the awareness, attitude and behavior in community group and reduces morbidity and mortality of cerebral apoplexy.