内科

目的构建医联体下三级支持系统，对农村缺血性脑卒中患者进行二级预防干预，对干预的效果进行分析。方法选取2019年1月至2020年6月我院神经内科收治的农村脑卒中患者99例为研究对象，采用随机数字法将纳入研究的患者分为观察组（49例）和对照组（50例）。对照组患者住院期间给予脑卒中常规护理及教育指导，出院后进行电话随访；观察组患者住院期间给予常规护理，进行脑卒中相关知识讲授、技能演示与指导，出院后采用三级支持系统进行脑卒中二级预防。比较两组患者出院后8个月内的脑卒中复发率；比较两组患者干预前后的不良生活方式改变情况、遵医行为情况、脑卒中危险因素控制情况。结果出院后8个月内，观察组患者的脑卒中复发率（9.09%）显著低于对照组（27.27%），差异有统计学意义（P＜0.05）。出院8个月后，观察组患者吸烟、饮酒的比例显著低于对照组，执行平衡膳食的比例显著高于对照组，坚持锻炼、坚持用药、坚持复诊及坚持自我监测的比例显著高于对照组，收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、糖化血红蛋白 (HbA1c)、低密度脂蛋白（LDL-C）、体质量指数（BMI）水平显著低于对照组，差异有统计学意义（P＜0.05）。结论构建医联体下三级支持系统，对农村缺血性脑卒中患者进行二级预防干预，能显著改善患者不良生活方式，提高患者遵医行为，减少脑卒中复发的危险因素，降低脑卒中的复发率。

ObjectiveTo constructed the three-level support system of medical treatment alliance, to intervene the secondary prevention in ischemic stroke patients in the rural areas, and to analyze the effects of the intervention. MethodsNinety-nine patients with stroke admitted to the Neurology Department of our hospital from January 2019 to June 2020 were selected as the research objects, and they were divided into observation group(49 cases) and control group (50 cases) by the random number method. Patients in the control group were given routine nursing and health education guidance during their hospitalization, and were followed up by telephone after discharge. Routine nursing were given, related knowledge of stroke were taught, and the skills of rehabilitation were guided to patients in the observation group during their hospitalization; after discharge, the three-level support system was used to intervene the secondary prevention of stroke. After 8 months of discharge, the recurrence rate of stroke between the two groups was compared. The change of unhealthy life style, the behavior status of following doctor’s instruction, control status of risk factors related to stroke were compared before and after intervention between the two groups. ResultsAfter 8 months of intervention, the recurrence rate of stroke in the observation group (9.09%) was significantly lower than that in the control group (27.27%) , with a statistically significant difference (P＜0.05). Compared to the control group, patients in the observation group obtained significantly lower rates of smoking and alcohol drinking, a higher proportion of conducting balanced diet, and significantly higher proportions of insisting rehabilitation exercises, the medicine administration, subsequent visit, and self-monitoring, whereas lower levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL-C) and body mass index (BMI), with statistically significant differences (P＜0.05). ConclusionConstructing the three-level support system of medical treatment alliance, then intervening the secondary prevention of ischemic stroke patients in the rural areas can help them improve their poor life style, improve compliance, and thus reduce the risk factors for stroke, as well as the recurrence rate of stroke.