中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2010年
1期
1-4
,共4页
王增武%王馨%张林峰%王文%陈伟伟%朱曼路%胡盛寿%雷振龙%孔灵芝%刘力生
王增武%王馨%張林峰%王文%陳偉偉%硃曼路%鬍盛壽%雷振龍%孔靈芝%劉力生
왕증무%왕형%장림봉%왕문%진위위%주만로%호성수%뢰진룡%공령지%류력생
高血压%社区卫生服务%疾病管理%干预效果
高血壓%社區衛生服務%疾病管理%榦預效果
고혈압%사구위생복무%질병관리%간예효과
Hypertension%Community health services%Disease management%Effect of intervention
目的 通过在社区开展高血压规范化管理,评价其对血压控制的效果.方法 以<中国高血压防治指南>为依据制定基层高血压规范化管理方案,进而用此方案对基层医务人员进行规范化培训,要求受训医务人员按照方案要求管理患者,主要进行非药物和药物干预、分级管理,每例患者至少管理1年.主要指标为血压控制率,干预效果为1年后的率(均值)-基线的率(均值).结果到2008年底,资料齐全且规范化管理满1年的患者共29411例(男性47.2%,年龄61.4岁±10.9岁).其中危险分层低危、中危、高危(很高危)者分别占8.9%、50.8%、40.3%.规范化管理后,患者的吸烟率、饮酒率的干预效果分别为-7.1%和-7.3%(P<0.05),SBP、DBP分别为-14.8mm Hg和-8.3mm Hg(P<0.05);而超重肥胖率较基线高0.3%(P>0.05).1年后高血压控制率上升至74.7%,干预效果为53.1%(P<0.05),各亚组患者的控制率均有显著升高;不同危险分层患者的血压控制率随管理时间延长而逐步升高.多因素logistic回归分析显示年龄大、男性、基线血压水平较高是高血压控制的不利因素.结论 在社区高血压患者中进行规范化管理可以显著改善高血压控制状况.
目的 通過在社區開展高血壓規範化管理,評價其對血壓控製的效果.方法 以<中國高血壓防治指南>為依據製定基層高血壓規範化管理方案,進而用此方案對基層醫務人員進行規範化培訓,要求受訓醫務人員按照方案要求管理患者,主要進行非藥物和藥物榦預、分級管理,每例患者至少管理1年.主要指標為血壓控製率,榦預效果為1年後的率(均值)-基線的率(均值).結果到2008年底,資料齊全且規範化管理滿1年的患者共29411例(男性47.2%,年齡61.4歲±10.9歲).其中危險分層低危、中危、高危(很高危)者分彆佔8.9%、50.8%、40.3%.規範化管理後,患者的吸煙率、飲酒率的榦預效果分彆為-7.1%和-7.3%(P<0.05),SBP、DBP分彆為-14.8mm Hg和-8.3mm Hg(P<0.05);而超重肥胖率較基線高0.3%(P>0.05).1年後高血壓控製率上升至74.7%,榦預效果為53.1%(P<0.05),各亞組患者的控製率均有顯著升高;不同危險分層患者的血壓控製率隨管理時間延長而逐步升高.多因素logistic迴歸分析顯示年齡大、男性、基線血壓水平較高是高血壓控製的不利因素.結論 在社區高血壓患者中進行規範化管理可以顯著改善高血壓控製狀況.
목적 통과재사구개전고혈압규범화관리,평개기대혈압공제적효과.방법 이<중국고혈압방치지남>위의거제정기층고혈압규범화관리방안,진이용차방안대기층의무인원진행규범화배훈,요구수훈의무인원안조방안요구관리환자,주요진행비약물화약물간예、분급관리,매례환자지소관리1년.주요지표위혈압공제솔,간예효과위1년후적솔(균치)-기선적솔(균치).결과도2008년저,자료제전차규범화관리만1년적환자공29411례(남성47.2%,년령61.4세±10.9세).기중위험분층저위、중위、고위(흔고위)자분별점8.9%、50.8%、40.3%.규범화관리후,환자적흡연솔、음주솔적간예효과분별위-7.1%화-7.3%(P<0.05),SBP、DBP분별위-14.8mm Hg화-8.3mm Hg(P<0.05);이초중비반솔교기선고0.3%(P>0.05).1년후고혈압공제솔상승지74.7%,간예효과위53.1%(P<0.05),각아조환자적공제솔균유현저승고;불동위험분층환자적혈압공제솔수관리시간연장이축보승고.다인소logistic회귀분석현시년령대、남성、기선혈압수평교고시고혈압공제적불리인소.결론 재사구고혈압환자중진행규범화관리가이현저개선고혈압공제상황.
Objective To determine the effects related to community-based standardized blood pressure management programs on the control of hypertension. Methods A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained using this protocol and required to manage hypertensive patients according to the protocol. Patients were treated on therapeutic life style change or/and medication, and followed up based on the criteria of risk stratification. The control rate of hypertension was evaluated after 1 year. Effect of intervention (EI) was estimated as '1 year rate (mean)' minus the number showed at the baseline. Results By the end of 2008, a total of 29 411 hypertensive patients (47.2% for male, mean age 61.4+10.9 years) with full information had been under management for one year according to the protocol. Among all patients, 8.9% were classified as under low risk, 50.8% as moderate risk and 40.3% as high and very high risk showed in baseline data. After standardized management, the EI of smoking, drinking and systolic/diastolic blood pressure were -7.1% (P<0.05) , -7.3% (P<0.05) , and-14.8/-8.3 mm Hg (P<0.05) , respectively. However, EI of overweight/obesity was 0.3% (P>0.05). For all patients, the control rate rose to 74.7%,with EI as 53.1%, and all of the sub-groups, including age, risk stratification, had significant increases. The longer the management was under, the higher the control rate was seen. Results from the multivariate logistic regression showed that older age, male and having higher blood level were adverse factors for the undertaking the control and management programs of hypertension. Conclusion Results from our study showed that standardized management could significantly improve the program on the control of hypertension at the community level, in China.
