摘要
目的观察社区综合防治健康管理模式对基层高血压患者控制率的影响。方法收集2012年7月至2013年7月广州参与研究的三级医院及6家社区卫生服务中心收治的初诊原发性高血压(高血压)患者2 383例,患者入组后随机分为综合管理组和常规治疗组。常规治疗组:按照高血压常规给予降压药治疗及根据血压情况作出调整。综合管理组:三级医院与社区卫生服务团队合作,运用综合防治健康管理模式治疗高血压患者,针对高血压危险因素进行筛查,在严格控制血压的同时,尽可能地干预危险因素,并进行定期随访(随访时间为12个月)。观察两组患者的血压控制水平、危险因素控制及高血压并发症发生情况等。结果随访12个月后,与常规治疗组相比,综合管理组依从性显著高于常规治疗组,不良反应少,差异有统计学意义(P<0.001)。综合管理组血压控制的显效率及总有效率显著高于常规管理组,而且收缩压、舒张压进一步改善,差异有统计学意义(P<0.001)。综合管理组吸烟、饮酒患者比例显著下降、基本身体指标(体质量指数、腰围)显著降低、血脂代谢紊乱情况改善、规律服用降压药物并定期监测血压患者比例显著增加,差异有统计学意义(P<0.001)。综合管理组随访期间发生包括脑卒中、心力衰竭、冠状动脉粥样硬化性心脏(冠心病)等并发症事件总发生率显著低于常规治疗组,差异有统计学意义(4.7%vs. 9.4%,P<0.001)。结论应用社区综合防治模式对基层高血压患者进行管理和干预,效果满意,值得临床推广应用。
Objectives To investigate the influence of comprehensive prevention and control measures on the control of hypertension of patients from grass-roots community.Methods Totally 2 383 cases of newly diagnosed hypertension patients were collected from July 2012 to July 2013 in the tertiary and 6 community hospitals in Guangzhou,which were randomly divided into general therapy group and comprehensive management group.In general therapy group,the patients were treated by general administration of antihypertensive drugs,which was modulated according to blood pressure.In comprehensive management group:the groups from the tertiary and community hospitals collaborated and the patients were treated by the integrated health management model.The risk factors of hypertension were screened and were interfered as much as possible when the blood pressure was strictly controlled and followed up regularly(followup duration:12 months).The control level of blood pressure,risk factors and the incidence of hypertension of the two groups were observed.Results After 12-month follow-up,patient..s compliance in comprehensive management group was significantly higher than that of general therapy group(P<0.001).Incidence of adverse reactions in comprehensive management group was less than that of general therapy group with a statistical significance (P<0.001).Total significant effective rate of blood pressure control in comprehensive management group was significantly higher than that in general therapy group,with systolic blood pressure,diastolic blood pressure further improved(P<0.001).As compared to general therapy group,in comprehensive management group,proportion of patients with smoking and drinking decreased significantly(P<0.001),basic body index(body mass index,waist circumference)decreased significantly (P<0.001),dyslipidemia improved (P<0.001),proportion of patients regularly taking antihypertensive drugs and monitoring their blood pressure increased(P<0.001).Overall incidence of complications in comprehensive treatment group was
作者
陈露丝
刘平方
李韶南
陈平安
吕何锦
刘震
CHEN Lu-si;LIU Ping-fang;LI Shao-nan;CHEN Ping-an;LV He-jin;LIU Zhen(Internal Medicine Department II,Guangzhou No.12 People′s Hospital,Guangzhou 510620,China;Department ofCardiology,Guangzhou First People′s Hospital,Guangzhou Medical University,Guangzhou 510180,China)
出处
《岭南心血管病杂志》
2019年第2期208-212,共5页
South China Journal of Cardiovascular Diseases
基金
广州市科技计划项目(2012Y2-00025)
关键词
高血压
社区综合防治模式
效果
hypertension
comprehensive intervention in community
effect
