摘要
背景糖尿病有着定期监测、实时随访、地域便利等社区管控的优势,社区规范管理现况有待进一步明确。目的了解并分析社区2型糖尿病患者阿司匹林一、二级预防使用现况。方法按照分层随机抽样原则,选取2017年12月上海市沪东社区卫生服务中心下设5个全科团队管控的2型糖尿病患者490例为调查对象。调查内容由问卷(基本信息、既往史、家族史、吸烟史、阿司匹林服用情况)、体检(体质量、血压)、实验室数据(血常规、肝肾功能、血糖、血脂)组成。依据冠状动脉粥样硬化性脑心血管疾病风险进行评定,了解阿司匹林一、二级预防在糖尿病患者中的使用现况,同时调查有预防指征而未用药的原因,以及预测高龄糖尿病患者阿司匹林预防使用的出血风险。结果最终纳入465例,其中男225例(48.4%),女240例(51.6%)。有阿司匹林一级预防指征者219例(47.1%),有阿司匹林二级预防指征者208例(44.7%),无阿司匹林预防指征者38例(8.2%)。有一级预防指征的糖尿病患者阿司匹林使用率为19.6%(43/219),有二级预防指征的糖尿病患者阿司匹林使用率为49.5%(103/208)。有阿司匹林预防指征但未用药原因中不知晓或医生未提及占比最大,为62.3%(175/281)。≥80岁年龄段的糖尿病患者使用阿司匹林预防者占50.0%(15/30),对其行抗血小板及抗凝治疗(CRUSADE)出血风险预测发现,出血风险高危者占26.7%(4/15),极高危者占13.3%(2/15)。结论社区糖尿病患者阿司匹林预防的使用率不足,特别是一级预防。对社区卫生服务中心管控的糖尿病患者,行阿司匹林脑心血管疾病一、二级预防,需要全科医生个体化评估其风险、获益,并进行动态规律随访。
Background For diabetic patients,community-based management is comparatively good,because by which glycemic and other essential indicators can be regularly monitored,real-time follow-up services can be obtained,and the management is easy to access owing to short spatial distance.However,how to deliver standardized community-based management for such patients is need to be cleared further.Objective To investigate the use of small-dose Aspirin for primary and secondary prevention of cardio-cerebrovascular diseases in community-dwelling type 2 diabetic patients.Methods We conducted this survey in December 2017 in a stratified and random sample of 490 type 2 diabetic patients who were under the management of 5 general practitioner teams from Shanghai Hudong Community Health Center.The survey contents consisted of 3 parts,namely,personal data(basic information,past history of ASCCVD,family history of ASCCVD,smoking history,and Aspirin use),anthropometric data(weight and blood pressure)and laboratory data(routine blood parameters,liver and kidney function parameters,and glycemic and lipid parameters),collected with a self-developed interview-based questionnaire,physical examination,fasting venous blood testing,respectively.Indications for using Aspirin for primary or secondary prevention of cardio-cerebrovascular diseases were assessed by the risk of developing ASCCVD,and the use status was evaluated.Reasons for those should use Aspirin but did not use were analyzed.Risk of Aspirin-related bleeding in the elderly was assessed.Results The study finally enrolled 465 cases,including 225(48.4%)males and 240(51.6%)females.Of them,219(47.1%)had indications for use of Aspirin for primary prevention of cardio-cerebrovascular diseases,with a rate of Aspirin use of 19.6%(43/219),208(44.7%)had indications for use of Aspirin for secondary prevention,showing a rate of Aspirin use of 49.5%(103/208),and other 38(8.2%)had no indications.Patients who had indications but did not use Aspirin were mostly due to knowing little about this or receiving no related information from the doctor〔62.3%(175/281)〕.The rate of using Aspirin for the prevention of cardio-cerebrovascular diseases in those aged≥80 years was 50.0%(15/30),and 26.7%(4/15)of them were at high risk of Aspirin-related bleeding,13.3%(2/15)were found with extremely high risk predicted by the CRUSADE score.Conclusion Inadequate use of Aspirin for prevention of diabetes in community,especially primary prevention.For type 2 diabetic patients under community-based management,before using Aspirin for primary or secondary prevention of cardiocerebrovascular diseases,individualized risk-benefit assessment of Aspirin use should be performed by GPs.Additionally,dynamic follow-ups should be delivered to the patients during Aspirin administration period.
作者
徐绮
施榕
杜兆辉
张林影
朱文奎
唐晓春
杨黎娟
薛伟斌
曹奕
乔慧华
涂东雁
赵辉
薛锦花
薛峰
王铭浩
刘连勇
XU Qi;SHI Rong;DU Zhaohui;ZHANG Linying;ZHU Wenkui;TANG Xiaochun;YANG Lijuan;XUE Weibin;CAO Yi;QIAO Huihua;TU Dongyan;ZHAO Hui;XUEJinhua;XUE Feng;WANG Minghao;LIU Lianyong(Shanghai Pudong New Area Hudong Community Health Center,Shanghai 200129,China;School of Public Health,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Pudong New Area Shanggang Community Health Center,Shanghai 200126,China;Endocrine Department,Shanghai Punan Hospital,Shanghai 200135,China)
出处
《中国全科医学》
CAS
北大核心
2019年第13期1623-1626,1631,共5页
Chinese General Practice
基金
上海市中西医结合学会社区医学与健康管理课题研究专项基金项目(SH201711)
上海市浦东新区卫生系统重要薄弱学科建设专项基金项目(PWZbr2017-07)
关键词
糖尿病
2型
阿司匹林
社区卫生服务
一级预防
二级预防
Diabete mellitus,type 2
Aspirin
Community health services
Primary prevention
Secondary prevention
