Zhongguo cuzhong zazhi (Mar 2025)

基于社区的卒中全生命周期健康管理模式研究进展 Research Progress on a Community-Based Full Life-Cycle Health Management Model for Stroke

  • 常丹凤1,申斗2,曹欣1,马可菲3,杨燕绥2,张玉哲4,池枫5,刘跃华2,高月霞1 (CHANG Danfeng1, SHEN Dou2, CAO Xin1, MA Kefei3, YANG Yansui2, ZHANG Yuzhe4, CHI Feng5, LIU Yuehua2, GAO Yuexia1)

DOI
https://doi.org/10.3969/j.issn.1673-5765.2025.03.006
Journal volume & issue
Vol. 20, no. 3
pp. 298 – 304

Abstract

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我国脑卒中防治“百万减残工程”提出卒中的全生命周期管理服务理念,致力于将卒中防治工作从传统的“疾病治疗”模式转变为“健康管理”模式。本文立足于社区在卒中防治中的独特优势,系统梳理了国内外基层社区卒中防治的服务实践、实施模式及干预策略,旨在为构建卒中全生命周期健康管理模式提供科学依据和实践参考。基于社区的卒中全生命周期健康管理模式可通过整合资源和技术,在动员社区参与、营造健康环境、早期预防与筛查、急性期快速响应、康复期整合型管理、动态随访以及提供心理和社会支持等方面形成创新性模式。该模式不仅有助于改善卒中患者的生活质量,还能有效减轻家庭及社会负担。 Abstract: The Stroke Prevention and Control “Million Reduction Disability Project” in China proposes the concept of full life-cycle health management services for stroke, aiming to transform stroke prevention and treatment from the traditional “disease treatment” model to the “health management” model. This paper, based on the unique advantages of communities in stroke prevention and treatment, systematically reviews the service practices, implementation models, and intervention strategies of stroke prevention and treatment in primary communities at home and abroad, aiming to provide scientific evidence and practical references for constructing a full life-cycle health management model for stroke. The community-based full life-cycle health management model for stroke can integrate resources and techniques to form an innovative model in mobilizing community participation, creating a healthy environment, early prevention and screening, rapid response during the acute phase, integrated management during the rehabilitation, dynamic follow-up, and providing psychological and social support. This model not only improves the quality of life for stroke patients but also effectively reduces the burden on families and society.

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