CAJ | 학술논문

目的调查上海市社区高血压患者药物治疗现况,分析其与降压达标的关系.方法 2011年5月至7月对上海市徐汇区5个社区纳入高血压规范化管理的47 572例高血压患者为基数,以简单随机抽样方法抽取3800例调查,由全科医师以面谈形式调查并填写问卷,了解社区高血压患者药物治疗与血压控制情况.结果共发放调查问卷3800份,回收问卷3328份(87.6％).应答者中社区≥65岁的老年高血压患者2305例(71.0％),合并有糖尿病、冠心病、卒中等慢性病的特殊高血压患者2158例(72.5％).“配药”是高血压患者就诊最主要的原因(2929例,90.9％),社区卫生服务中心是高血压患者就诊的最主要医疗机构(2146例,76.8％).仅454例(14.4％)患者知道所服药物的主要不良反应.普通高血压患者、老年高血压患者和特殊高血压患者降压治疗的达标率分别为62.5％(235/376)、75.9％ (487/642)和17.8％(328/1839).65.4％(2176/3328)的患者为单药治疗,仅28.6％(952/3328)的患者采用联合药物治疗；2.3％(76/3328)的患者经常自行调节药物；而在降压药物的选择和联合使用方面,中成药的使用比例较高(571/3378,16.9％).口服1种降压药物较口服2、3种药物治疗的患者血压达标率更高(OR值分别为0.664、0.427,P＜0.001、P=0.002)；在单药治疗者中,使用中成药较钙拮抗剂治疗的患者血压达标率更高(OR=1.717,P＜0.001).结论社区内合并有慢性病的特殊高血压患者血压达标率较低,其主要原因为目前社区内降压药物治疗不规范和对不同人群的血压控制标准缺乏重视.应在社区开展高血压防治基层指南的继续教育,加深全科医师对指南的理解和运用,重视特殊高血压患者的血压达标情况.
목적 조사상해시사구고혈압환자약물치료현황,분석기여강압체표적관계.방법 2011년5월지7월대상해시서회구5개사구납입고혈압규범화관리적47 572례고혈압환자위기수,이간단수궤추양방법추취3800례조사,유전과의사이면담형식조사병전사문권,료해사구고혈압환자약물치료여혈압공제정황.결과 공발방조사문권3800빈,회수문권3328빈(87.6％).응답자중사구≥65세적노년고혈압환자2305례(71.0％),합병유당뇨병、관심병、졸중등만성병적특수고혈압환자2158례(72.5％).“배약”시고혈압환자취진최주요적원인(2929례,90.9％),사구위생복무중심시고혈압환자취진적최주요의료궤구(2146례,76.8％).부454례(14.4％)환자지도소복약물적주요불량반응.보통고혈압환자、노년고혈압환자화특수고혈압환자강압치료적체표솔분별위62.5％(235/376)、75.9％ (487/642)화17.8％(328/1839).65.4％(2176/3328)적환자위단약치료,부28.6％(952/3328)적환자채용연합약물치료；2.3％(76/3328)적환자경상자행조절약물；이재강압약물적선택화연합사용방면,중성약적사용비례교고(571/3378,16.9％).구복1충강압약물교구복2、3충약물치료적환자혈압체표솔경고(OR치분별위0.664、0.427,P＜0.001、P=0.002)；재단약치료자중,사용중성약교개길항제치료적환자혈압체표솔경고(OR=1.717,P＜0.001).결론 사구내합병유만성병적특수고혈압환자혈압체표솔교저,기주요원인위목전사구내강압약물치료불규범화대불동인군적혈압공제표준결핍중시.응재사구개전고혈압방치기층지남적계속교육,가심전과의사대지남적리해화운용,중시특수고혈압환자적혈압체표정황.
Objective To investigate pharmacotherapy in patients with hypertension in community of Shanghai Xuhui District and the related factors related to blood pressure control.Methods A crosssectional sampling survey was undertaken in 47 572 patients incorporated into standardized management of hypertension from 5 communities in Xuhui District of Shanghai during May 2011 to July 2011.Results Total 3800 questionnaires were distributed and 3328 (87.6％) were returned.Among all patients elderly cases accounted for 71.0％ (2305/3247); special patients complicated with other diseases,including diabetes mellitus,coronary heart disease and stroke accounted for 72.5％ (2158/2978).To make up a prescriptionwas the primary reason of encounter (2929,90.9％) and 76.8％ choose community health service center.Only 454(14.4％) patients knew the major adverse effects of their antihypertensive drugs.The blood pressure control rates in common,elderly and special patients were 62.5％ (235/376),75.9％ (487/642) and 17.8％ (328/1839),respectively.65.4％ (2176/3328) patients choose monotherapy,only 28.6％ (952/3328) used more than 2 drugs and 2.3％ (76/3328) patients adjusted drugs by themselves.Additional use Chinese medicine (571/3378,16.9％) was common in community.The blood pressure control rate in patients using monotherapy was higher than that in patients using more than 2 drugs (OR =0.664,OR =0.427,P ＜ 0.001,P =0.002).In monotherapy,the control rate of patients using additional Chinese medicine was higher than those used calcium channel blockers (OR =1.717,P ＜0.001).Conclusions The results indicate that the blood pressure control rate in patients complicated with other chronic diseases is very low in communities; which were associated with non-standard medication and inadequate attention on blood pressure control standards in different populations.