【作者】 王艳梅；

【导师】 王爽；

【作者基本信息】 中国医科大学 ， 全科医学（专业学位）， 2023， 硕士

【摘要】 目的:了解家庭医生签约老年动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular diseases,ASCVD)高危人群危险因素控制情况,分析影响该人群血压、血脂、血糖达标的可能因素,为进一步提高老年ASCVD高危人群危险因素控制率提供基线数据,并探讨优化现行家庭医生签约服务模式的具体措施。方法:在辽宁省东西南北中各抽取一个市,即辽中的沈阳市、辽东的丹东市、辽西的朝阳市、辽南的大连市和辽北的抚顺市,在各市全科医学住培基地抽取一家社区卫生服务中心,筛选社区卫生服务中心签约家庭医生服务1年以上的老年ASCVD高危人群作为研究对象,按照整群抽样方法计算样本量,并将人群按照体检顺序排序抽取。本研究遵循自愿参加的原则,依据纳入标准与排除标准,共纳入299人作为研究对象。采用通过居民健康档案收集和问卷调查相结合方法获得患者基本信息、生活方式、心血管病相关病史,用药史,危险因素控制水平,积极度,用药依从性等数据,分析总体危险因素综合控制率等指标。结果:1、本研究选取辽宁省5个市的签约家庭医生的老年ASCVD高危人群,筛查出ASCVD高危人群检出率为53.21%,沈阳市55.12%,丹东市56.86%,大连市46.40%,朝阳市50.78%。依据纳入及排除标准共纳入老年人299人,年龄范围65-91岁,平均年龄72.81±6.28岁。其中男性187人(62.54%),女性112人(37.46%)。2、慢性病患病情况:超重者及肥胖者165人(55.18%),未超重者134人(44.82%)。高血压、糖尿病、血脂异常患病率分别为77.92%、59.87%、69.90%。3、高血压组控制率69.96%;糖尿病组空腹血糖控制率50.28%;在169个诊断血脂异常且有低密度脂蛋白指标的患者中,低密度脂蛋白控制率为35.50%,综合控制率为25.21%。4、目前月均医疗费用是否超过月均可支配收入情况中,超支人群的综合控制可能是未超标人群的-1.013倍(95%CI:0.146～0.906,P=0.030);经常锻炼及每天锻炼人群对比偶尔或不锻炼的人群,综合控制率可高0.888倍(95%CI:1.006～5.870,P=0.049);积极度与血脂血压血糖的综合控制率为正相关,相关系数为0.250(95%CI:1.193～1.383,P<0.001)。结论:本研究辽宁省老年人群ASCVD高危人群检出率较高;家庭签约的老年ASCVD高危人群高血压的控制率明显较高、糖尿病的控制率较高、血脂异常的控制率明显较高,但综合控制率尚不理想;医疗费用超支、运动与积极度与患者综合控制相关。建议家庭医生应继续做好以人为中心的慢性病管理工作,进一步改善ASCVD主要危险因素控制率,做好ASCVD的一级预防,提高老年人的生活质量。更多还原

【Abstract】 Objective: To understand the risk factors control status of atherosclerotic cardiovascular diseases(ASCVD)high-risk groups signed by family physician,and analyze the possible factors affecting the level of blood pressure,blood lipids and bloodglucose of the population.To provide baseline data to further improve the risk factor control rate of the elderly population at high risk of ASCVD,and explore specific measures to optimize the current contract service mode of family physician.Methods: A community health service center was selected from a general practice residential training base in each city of Liaoning Province,including Shenyang in central Liaoning,Dandong in eastern Liaoning,Chaoyang in western Liaoning,Dalian in southern Liaoning,and Fushun in northern Liaoning.Elderly ASCVD high-risk individuals who have been contracted by family doctors for more than 1 year in community health service centers were selected as research subjects,and the sample size was calculated using cluster sampling method,Sort according to the order of physical examination and randomly select.This study follows the principle of voluntary participation,and based on the inclusion and exclusion criteria,a total of 299 people were included as the research subjects.By combining the collection of residents’ health records with a questionnaire survey,basic information,lifestyle,cardiovascular disease related medical history,medication history,risk factor control level,positivity,medication compliance,and other data of patients were obtained.The overall risk factor comprehensive control rate and other indicators were analyzed.Results: 1.This study selected the elderly ASCVD high-risk groups from the contracted family doctors in five cities of Liaoning Province,and the screening rate of ASCVD highrisk groups was 53.21%,55.12% in Shenyang,56.86% in Dandong,46.40% in Dalian and50.78% in Chaoyang.According to the inclusion and exclusion criteria,a total of 299 elderly people were included,with an age range of 65-91 years and an average age of72.81±6.28 years.Among them,187 men(62.54%)and 112 women(37.46%).2.Prevalence of chronic diseases: 165(55.18%)were overweight and obese,and 134(44.82%)were not overweight.The prevalence rates of hypertension,diabetes and dyslipidemia were 77.92%,59.87% and 69.90% respectively.3.The control rate of hypertension group was 69.96%;The rate of reaching the standard of fasting blood glucose control in diabetes group was 50.28%;Among 169 patients diagnosed with dyslipidemia and with low density lipoprotein index,the control rate of low density lipoprotein was35.50%,the comprehensive control rate is 25.21%.4.In the current situation of whether the average monthly medical expenses exceed the monthly disposable income,the comprehensive control of the overspended population may be-1.013 times that of the nonoverspended population(95% CI: 0.146～0.906,P=0.030);Compared with those who do not exercise or rarely,the comprehensive control of people who exercise regularly and daily can be 0.888 times higher(95% CI: 1.006～5.870,P=0.049);The degree of enthusiasm is positively correlated with the comprehensive control of blood lipids,blood pressure and blood glucose,and the correlation coefficient is 0.250(95% CI: 1.193～1.383,P<0.001).Conclusion: The detection rate of ASCVD high-risk population in the elderly population of Liaoning Province is relatively high in this study;The control rate of hypertension,diabetes and dyslipidemia in the elderly ASCVD high-risk group who signed a family contract were significantly higher,but the comprehensive control rate was not ideal;Medical cost overruns,exercise and motivation are related to comprehensive patient control.It is recommended that family doctors continue to do a good job in people-centered chronic disease management,further improve the control rate of major risk factors for ASCVD,do a good job in primary prevention of ASCVD,and improve the quality of life of the elderly.更多还原