关键词: 卒中筛查; 社区; 规范化管理; 效果

Abstract:

Objective To investigate the effectiveness of community-based stroke risk factors screening and standardized management in Nanchang city, and to understand the prevalence of high risk population of stroke in different population in Nanchang area. 

Methods Stroke risk factors were evaluated by questionnaire and physical examination in rural inhabitants, urban inhabitants, and teachers in different communities of in Nanchang city. The people who had more than three risk factors were considered as high-risk people of stroke. The high-risk people were given 3-year of standardized management including changing the life style and/or drugs intervention. The risk factors were re-assessed after 3 years to evaluate the effect of these intervention.

Results Of 746 rural inhabitants who participated in the screening, 177 (23.72%) were at high risk, and the mean score of risk factor assessment by questionnaire was (3.30±0.59). Of 1005 urban inhabitants who participated in the screening, 281 (27.96%) were at high risk, and the mean score of risk factor assessment was (3.68±0.78). Of 1359 teachers having undergone the screening, 172 (12.66%) were at high risk, and the mean score was (3.21±0.51). All the high-risk subjects were given standardized management, and their risk factors and prognosis including new-onset stroke and death were re-evaluated after 3 years. After 3 years, of the rural inhabitants, 5 people occurred new-onset stroke, 5 died from stroke, 1 died from other disease, 19 high-risk persons improved into non-high risk ones by intervention, and their mean score of risk factor assessment dropped to (2.97±0.55) (P <0.001); of urban inhabitants, 5 people occurred new-onset stroke, 5 died from recurrent stroke, 88 highrisk persons improved into non-high risk ones, their mean score decreased to (2.75±0.72) (P <0.001); of teachers, 2 persons occurred new-onset stroke, 1 person died from recurrent stroke, 59 high-risk persons improved into non-high risk ones, and their mean score declined to (2.81±0.78) (P <0.001). A total of 51 persons underwent artery stenting for symptomatic intracranial and/or extracranial arterial stenosis, 8 persons underwent aneurysm embolization for intracranial aneurysms. The top three risk factors in rural inhabitants were dyslipidemia (72.88%), hypertension (58.19%) and obesity (46.33%); the three ones in urban inhabitants were hypertension (77.22%), dyslipidemia (58.36%) and obesity (54.80%); and the three ones in teachers were lack of exercise (86.05%), dyslipidemia (84.84%) and hypertension (62.79%). 

Conclusions The difference in the prevalence of high-risk people and the distribution of high risk factors in different population may be related to dietary structure and education level; and standardized management achieved a good effect in high-risk individuals in different population. These findings demonstrated the feasibility and usefulness of community-based stroke risk factors screening and management.

Key words: Stroke screening; Community; Standardized management; Effectiveness