Discussion And Practice Of Early Stroke Intervention Based On The Hierarchical Diagnosis And Treatment Model

Objective:In this study,through the screening and risk factor intervention of high risk stroke population as a breakthrough,develop workflow of stroke screening and risk factor intervention,Driven graded diagnosis and treatment and two-way referrals.To study the screening and early intervention methods of high risk population of stroke,to explore the effective methods to reduce the incidence of stroke in community residents.Methods:Set up close medical association with tertiary hospital,set up screening management team on high risk population of stroke,develop and set screening plan,"Risk score card of Stroke",referrals process,intervention path and so on,and training to the medical participate while screening.Select preliminary screening target.The residents over 50 years old under Liuyuan Community Healthcare Center.According to the "Medium risk score card" from face-to-face score screening.After primary screening,the patients with high risk of stroke were selected for next clinical analysis.Informed these patients to carry out carotid ultrasound and homocysteine examination.The residents who joined in screening from January 2016 to December 2018 were divided to groups according to the results of screening and carotid artery examination,and carry out community intervention.To observe the disease knowledge,lifestyle,blood pressure control,blood glucose control and so on.Record the ultrasound results of the selected candidates before and after management,and knowledge level of lifestyle and disease.After the data enter into the Excel table,the statistics are carried out with SPSS22.0 software."[n(%)]",x2 is used to represent and verify the counting data,respectively."(±s)and t were used to express and test the measurement data,and the difference values were statistically significant(P < 0.05).Results:A total of 17274 people were screened in this study,including 7627 males with an average age of 67.97 years and 9647 females with an average age of 66.42 years.2338(13.53%)of the high risk personnel were screened,and the proportion of male high risk(15.9%)was significantly higher than that of female(11.66%).The distribution of risk factors was 61.05% overweight,39.51% hypertension,37.21%hyperlipidemia,15.65% diabetes,14.24% lack of exercise,10.10% smoking,6.19%family history of stroke,5.12% history of stroke or TIA.,atrial fibrillation was 0.92%.931 cases of carotid ultrasound examination were performed in the high risk population,including 13 cases of severe stenosis(1.40%),58 cases of unstable plaque(6.23%),345 cases of stable plaque(37.06%),139 cases of thickening of media(20.62%)and 323 cases(34.69%)of normal.One year after intervention according to screening and carotid plaque results,the number of people with normal weight increased by 760,eating green vegetables by3903,physical exercise by 1230,light diet by 2603;quitting smoking by 878,quitting drinking by 790,reduction in high-fat diet by 3683.In terms of drug specifications,the use of statins increased by 1305,antiplatelet drugs increased by589,and antihomocysteinemia(folic acid,vitamin B12)increased by 344.The norms for the use of some drugs,especially statins,are obvious.All of them were statistically significant(P < 0.05).There was no significant difference between the two groups.In the control of chronic diseases,the control rate of hyperlipidemia increased by 1328 patients compared with that before management.There were statistical differences among the three groups.There were 16 cases of new stroke in2017,the incidence rate was 299.7 / 100000 years,14 cases in 2018,267.5 / 100000 cases.Conclusion:The intervention team of the "Level III Hospital Specialist-Community Practice Team" group is beneficial to the screening of high-risk factors of stroke and thefeasible follow-up management.The risk factor of stroke is higher than that of women in screening,and the proportion of high-risk group of stroke is increased with the increase of age.The formation and severity of carotid plaque was significantly higher in men than in women.After the intervention of the stratified group,the risk factors are improved obviously,and the drug use is more standardized.The incidence of stroke was significantly lower than that of epidemiological statistics.