目的：开展慢性病综合干预研究实践，评估宝鸡市陇县健康人群慢性病干预试点实施效果。方法选取2014年9月至2015年9月宝鸡市陇县2个镇村（东南镇河沟村和东风镇西沟村）18岁以上常住居民226人作为研究对象，将其分为干预组（91人）和对照组（135人），将两组研究对象分为健康人群、高危人群和慢性病人群，对干预组分别实施健康教育干预、生活行为方式干预和患者健康管理3类干预措施，分析健康人群实施健康教育干预措施后的效果。其中干预组在实施2014年第一阶段4次集中干预（基线时）的基础上于2015年5~9月进行3次不断重复干预，且每次干预前均采用问卷调查测量上次干预后的变化情况。对照组未采取干预措施，仅调查基线和评估时各指标值。结果实施干预后，在吸烟危害知晓评分、饮酒危害知晓评分、高危人群特征知晓评分、糖尿病典型症状知晓、糖尿病预防评分方面干预组均高于对照组，差异均有统计学意义（P＜0.05）；而在吸烟者、二手烟暴露、体质量指数方面比较，差异均无统计学意义（P>0.05）。提高了健康人群慢性病防控核心知识知晓率，部分改善了膳食摄入情况，而戒烟限酒、适量运动等健康生活行为方式干预效果不明显。结论慢性病患者应不断给予强化，长期干预，使慢性病健康人群居民保持戒烟限酒、合理膳食、适量运动等健康生活行为方式。%Objective To carry out a chronic diseases comprehensive intervention research practice and to evaluate the implementation effects of chronic diseases intervention pilot among healthy population in Longxian County of Baoji City. Methods Two hundreds and twenty-six permanent residents aged more than 18 years old from 2 villages and towns (Hegou village of Dongnan Town and Xigou village of Dongfeng town ) were selected as the research subjects and divided into the intervention group (91 persons)and control group(135 persons). Then the research subjects in the two groups were divided into the healthy population , high-risk population and chronic disease population according to the related standard. The 3 kinds of health education interven-tion,life behavior style intervention and patient health management were respectively implemented. The effect after implementing the health education interventional measures in the health population was analyzed. The intervention group was implemented 4 times of centralized intervention in 2014 and 3 times of repeating intervention in 2015 ,moreover the change situation after previ-ous intervention was measured before each intervention by using the questionnaire survey. The control group did not adopt the in-tervention measures. The base line and indicator value at evaluation were surveyed only. Results The scores of awareness of smoking harm,awareness of drinking harm,awareness of high risk population characteristics,awareness of diabetic typical symp-toms and diabetic prevention after intervention in the intervention group were higher than those in the control group ,and the dif-ference was statistically significant(P<0.05);but the comparison in the aspects of second-hand smoking exposure and body mass in-dex(BMI) showed no statistical difference(P>0.05). The awareness rate of core knowledge of chronic disease prevention and con-trol in the health population was increased. The dietary intake situation was partially improved ,but the intervention effect in the healthy life behavior style such as quitting smoking ,limiting drinking and appropriate exercise was not obvious. Conclusion The patients with chronic diseases should be constantly given the reinforcement and long-term intervention in order to make the chronic disease health population to maintain the health life behavior style of quitting smoking ,limiting drinking and appropriate exercise.
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