杭州市血脂异常社区分级管理效果及影响因素研究

发布时间：2018-11-16 10:19

【摘要】：目的评价2014-2015年杭州市成年人血脂异常社区干预项目干预效果,分析社区血脂异常管理的影响因素,探索血脂异常的社区分级管理模式,为进一步完善及推广更全面有效的血脂异常社区综合管理方法提供借鉴。方法1、对象:采用多阶段分层随机抽样,按照10%比例从杭州市成人血脂异常社区干预项目应纳入管理的25577例血脂异常患者中抽取2498例作为干预组,另抽取1020例未纳入管理的血脂异常患者作为对照组。2、内容:本研究分析血脂异常社区分级管理效果,主要包括干预前后血脂指标水平及血脂管理达标率,并分析管理效果的影响因素。3、数据统计分析:采用SPSS 17.0统计软件进行统计分析,统计方法采用描述性分析、Pearson χ2检验、独立样本t检验、配对样本t检验、单因素非条件logistic回归分析、多因素非条件logistic回归分析。结果1、干预组与对照组人口学特征差别无统计学意义,干预组患者与全科医生签约率显著高于对照组。2、干预组与对照组基期血脂水平无统计学差异,干预后干预组TC、TG、LDL-C指标水平较基期显著降低,且显著低于对照,HDL-C水平与基期无显著差异。3、干预组预对照组基期TC、LDL-C管理达标率无统计学差异,干预后干预组TC、LDL-C达标率均显著高于对照组。4、干预后干预组生活方式、血脂相关知信行等血脂水平影响因素情况均优于对照组,干预组在干预期间接受全科医生随访次数显著高于对照组。5、收缩压水平升高、吸烟量增大、蔬菜摄入减少、水果摄入减少、合并高血压、合并糖尿病、合并代谢综合征、合并其他动脉粥样硬化疾病、未开始血脂控制、干预期间血脂检测次数减少是血脂异常患者血脂指标达标的危险因素。结论1、血脂异常社区分级管理可有效降低患者TC、TG、LDL-C。2、血脂异常社区分级管理对患者HDL-C影响不显著。3、血脂异常社区分级管理能切实提高血脂控制达标率。4、收缩压水平升高、吸烟量增大、蔬菜摄入减少、合并高血压、合并糖尿病、合并代谢综合征、合并其他动脉粥样硬化疾病、未开始血脂控制、干预期间血脂检测次数减少是血脂异常患者血脂指标达标的危险因素。5、中国血脂异常社区分级管理工作有待进一步发展完善。
[Abstract]:Objective to evaluate the intervention effect of community intervention project on adult dyslipidemia in Hangzhou from 2014 to 2015, analyze the influencing factors of community dyslipidemia management, and explore the community grading management model of dyslipidemia. To further improve and promote more comprehensive and effective community management of dyslipidemia. Methods 1. Participants: 2498 patients with dyslipidemia were selected as intervention group from 25577 patients with dyslipidemia who should be included in the community intervention project of adult dyslipidemia in Hangzhou according to the proportion of 10% by multi-stage stratified random sampling. In addition, 1020 patients with dyslipidemia were selected as control group. 2. Content: this study analyzed the effect of community grading management of dyslipidemia, including the level of blood lipid index and the rate of reaching the standard of lipid management before and after intervention. The influencing factors of management effect were analyzed. 3. Statistical analysis of data: statistical analysis was carried out by SPSS 17.0 statistical software. The statistical methods were descriptive analysis, Pearson 蠂 2 test, independent sample t test, paired sample t test. Univariate unconditioned logistic regression analysis and multivariate unconditioned logistic regression analysis. Results 1. There was no significant difference in demographic characteristics between the intervention group and the control group. The signing rate between the patients and the general practitioner in the intervention group was significantly higher than that in the control group. 2. There was no significant difference in blood lipid levels between the intervention group and the control group. After intervention, the TC, in the intervention group was higher than that in the control group. The level of TG,LDL-C was significantly lower than that of the base period, and significantly lower than that of the control. There was no significant difference between the HDL-C level and the base period. 3. There was no significant difference in TC,LDL-C management compliance rate between the intervention group and the pre-control group. After intervention, the TC, level in the intervention group was not significantly different. The rate of reaching the standard of LDL-C was significantly higher than that of the control group. 4. After intervention, the influencing factors of life style, blood lipid related knowledge, faith and behavior of intervention group were better than those of control group. In the intervention group, the number of follow-up by general practitioners was significantly higher than that of the control group. 5. The systolic blood pressure level increased, smoking increased, vegetable intake decreased, fruit intake decreased, hypertension, diabetes mellitus, and metabolic syndrome. With other atherosclerotic diseases, blood lipids were not controlled, and the decrease of blood lipids during intervention was the risk factor for the patients with dyslipidemia to reach the standard of blood lipids. Conclusion 1. Community grading management of dyslipidemia can effectively reduce the effect of community grading management on HDL-C in patients with TC,TG,LDL-C.2, dyslipidemia. 3. Community grading management of dyslipidemia can effectively improve the control rate of blood lipids. 4. The systolic blood pressure level is increased, the amount of smoking is increased, the intake of vegetables is reduced, the patients with hypertension, diabetes mellitus, and metabolic syndrome are complicated with hyperlipidemia, diabetes mellitus and metabolic syndrome. With other atherosclerotic diseases, blood lipid control was not initiated. The decrease of blood lipid test times during intervention was the risk factor of blood lipid index in patients with dyslipidemia. Community grading management of dyslipidemia in China needs further development and improvement.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.2

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