摘要
目的调查老年高血压患者在门诊的综合干预情况。方法采用问卷调查、体格检查、实验室检查和查阅门诊病历方法,对2010年9～10月在我院老年科门诊就诊的高血压患者533例进行分析。结果 533例中合并有心血管病、糖尿病、慢性肾脏病的患者占67.54%。所有患者均完善高血压相关的实验室检查;高血压诊断中对血压分级占22.89%,评估心血管危险分层占19.89%。大多数患者接受过非药物治疗宣教,宣教频率不高。高血压治疗率为82.36%,控制率为62.85%;高危患者的治疗率为84.59%,高于中危患者76.66%(P<0.05);控制率为56.91%显著低于中危患者78.00%(P<0.01);降压药物中血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体抑制剂(ARB)的使用率最高占69.47%。高危和极高危患者中低密度脂蛋白胆固醇达标者分别占51.40%和31.42%,他汀类药物使用者分别占26.99%和32.85%。符合二级预防和一级预防患者中阿司匹林使用率分别为61.96%和42.85%。糖尿病患者糖化血红蛋白<7.5%者占96.07%。结论门诊老年高血压患者的心血管危险评估明显欠缺;非药物治疗宣教、降压、调脂、抗血小板和降糖等综合干预,尤其是他汀类药物和阿司匹林的应用干预存在不足;应强化医生对指南的学习,加强对老年高血压患者的综合干预。
Objective To investigate the comprehensive intervention of hypertension in elderly outpatients. Methods From September to October 2010,533 elderly outpatients with hypertension were enrolled in this research. Each patient was invited to receive a set of standardized questionnaire, physical examination, laboratory tests and case history ex- amination. Results （ 1 ） Totally 67. 54% of patients were complicated with cardiovascular disease, chronic kidney dis- ease or diabetes. （2） All patients completed laboratory tests relevant to hypertension. 22. 89% and 19. 89% patients were evaluated respectively on blood pressure （BP） grade and cardiovascular risk stratification. （3） Most of patients received the education about non-drug therapy, and the frequency of education was not high. （4） The rate of treatment and control of hypertension was 82. 36% and 62. 85% respectively. Compared with middle-risk patients, high-risk patients had higher treatment rate （76. 66% vs 84. 59%, P 〈0. 05）, but significantly lower control rate（78.00% vs 56. 91% ,P 〈0. 01 ）. 69.47% of the patients took ACE1 or ARB. The level of LDL-C in 51.40% of the patients with high risk and in 31.42% with very high risk was controlled, and the rate of statin use in the two groups was 26. 99% and 32. 85% respectively. （5） The patients using aspirin accounted for 61.96% in secondary and 42. 85% in primary prevention. （6） The level of HbAlc in 96. 07% of the patients with diabetes was controlled under 7.5%. Conclusions The majority of elderly out- patients with hypertension are not evaluated on cardiovascular risk stratification. Comprehensive intervention including edu- cation of non-drug therapy, antihypertension, lipid control, anti-platelet, glucose control, especially the use of statin and aspirin is not sufficient. Clinical doctors should learn more about the guideline so as to strengthen comprehensive interven- tion.
出处
《实用老年医学》
CAS
2012年第4期319-322,共4页
Practical Geriatrics
关键词
高血压
老年人
门诊患者
综合干预
hypertension
aged
outpatient
comprehensive intervention
