CAJ | 학술논문

目的：探讨盐敏感人群筛查对社区高血压管理的影响。方法选择2012年3月在友协社区卫生服务中心参加慢性高血压管理的原发性高血压病患者989例作为观察组，同时选择2012年3月在建安社区卫生服务中心参加慢性高血压管理的原发性高血压病患者914例作为对照组。观察组进行盐负荷试验，并对其中筛查出的盐敏感人群采取个体化治疗方案，对照组未行盐负荷试验；两组均按照社区要求进行常规随访及健康指导。测量两组患者研究前及研究3、6个月后的平均动脉压（MABP）及研究6个月时主要心脑血管疾病的发生率（包括脑梗死、短暂脑缺血发作、冠心病、心绞痛急性发作、急性心肌梗死及心脑血管疾病死亡事件）。结果观察组筛查出盐敏感患者614例，占62.1%。两组研究前后 MABP 比较，差异均有统计学意义（P ﹤0.05）。组间比较，两组研究前 MABP 比较，差异无统计学意义（P ﹥0.05）；观察组研究3、6个月后的 MABP 均低于对照组（P ﹤0.05）。组内比较，两组研究3、6个月后的 MABP 均低于研究前，且两组研究6个月后的 MABP 低于研究3个月后( P ﹤0.05)。对照组主要心脑血管疾病的发生率为19.1%（175/914），高于观察组的9.6%（95/989），差异有统计学意义（χ2＝25.7，P ﹤0.05）。其中观察组脑梗死和短暂性脑缺血发作发生率低于对照组（P ﹤0.05）。结论进行盐敏感人群筛查，并给予个体化治疗可以改善社区高血压管理患者的血压水平，同时降低心脑血管疾病发生率，为社区高血压管理提供了有益的参考价值。
목적：탐토염민감인군사사대사구고혈압관리적영향。방법선택2012년3월재우협사구위생복무중심삼가만성고혈압관리적원발성고혈압병환자989례작위관찰조，동시선택2012년3월재건안사구위생복무중심삼가만성고혈압관리적원발성고혈압병환자914례작위대조조。관찰조진행염부하시험，병대기중사사출적염민감인군채취개체화치료방안，대조조미행염부하시험；량조균안조사구요구진행상규수방급건강지도。측량량조환자연구전급연구3、6개월후적평균동맥압（MABP）급연구6개월시주요심뇌혈관질병적발생솔（포괄뇌경사、단잠뇌결혈발작、관심병、심교통급성발작、급성심기경사급심뇌혈관질병사망사건）。결과관찰조사사출염민감환자614례，점62.1%。량조연구전후 MABP 비교，차이균유통계학의의（P ﹤0.05）。조간비교，량조연구전 MABP 비교，차이무통계학의의（P ﹥0.05）；관찰조연구3、6개월후적 MABP 균저우대조조（P ﹤0.05）。조내비교，량조연구3、6개월후적 MABP 균저우연구전，차량조연구6개월후적 MABP 저우연구3개월후( P ﹤0.05)。대조조주요심뇌혈관질병적발생솔위19.1%（175/914），고우관찰조적9.6%（95/989），차이유통계학의의（χ2＝25.7，P ﹤0.05）。기중관찰조뇌경사화단잠성뇌결혈발작발생솔저우대조조（P ﹤0.05）。결론진행염민감인군사사，병급여개체화치료가이개선사구고혈압관리환자적혈압수평，동시강저심뇌혈관질병발생솔，위사구고혈압관리제공료유익적삼고개치。
Objective To explore the effects of salt - sensitive population screening on community hypertension man-agement. Methods March 2012 a total of 989 essential hypertension(EH)patients participating chronic hypertension manage-ment program(CHMP)in Youxie Community Health Service Center(CHSC)were enrolled as study group,another 914 EH pa-tients participating CHMP in Jianan CHSC as control group. A salt load test was made in study group and the screened - out salt- sensitive patients were given individualized treatments. The 2 groups had conventional follow - ups and health guidance. Mean arterial pressure(MABP)was measured before research and in months 3,6 after,and the incidences of the main cardiovascular and cerebrovascular diseases including cerebral infarction(CI),transient ischemic attack(TIA),coronary heart disease,an-gina pectoris,acute myocardial infarction,cardiovascular disease deaths at 6 months folluwed - up. Results A total of 614 salt- sensitive patients were screened out,accounting for 62. 1% of EH patients. There was significant difference between pre -and post - treatment MABP between 2 groups(P ﹤ 0. 05). There was no difference in MABP between 2 groups before research (P ﹥ 0. 05). MABP was lower in study group than in control group in months 3,6 after research(P ﹤ 0. 05),and lower in months 3,6 after research than before,and lower in months 6 than in months 3 between 2 groups(P ﹤ 0. 05). The 68. 3%(676 / 989)patients had drops of blood pressure(BP)in study group. The incidence of the main cardiovascular and cerebrovas-cular diseases was 19. 1% (175 / 914)in control group,higher than that of study group〔9. 6% (95 / 989)〕,the difference was significant(χ2 = 25. 7,P ﹤ 0. 05). The incidences of CI,TIA were lower in study group than in control group( P ﹤0. 05). Conclusion Salt - sensitivity screening and individualized treatments can improve the BP of hypertensive patients par-ticipating CHMP and reduce the incidence of cardiovascular and cerebrovascular diseases,to provide useful reference for commu-nity hypertension management.