CAJ | 학술논문

目的：分析中老年妇女高血压社区规范化项目管理模式及其效果，为完善社区卫生服务体系提供基层资料。方法选择45～63岁在本中心辖区确诊为高血压病（288人）及高危者（101人）为研究对象，实施有关高血压的知识、态度和行为等基线调查，据2010中国高血压防治指南，建立健康档案，实行分级管理，随访包括血压测量、健康教育和治疗方案调整，在基线调查的基础上，实施为期2年的社区规范管理。结果实施规范管理后，中老年高血压高危妇女在高血压知识、态度和行为方面的正确率均有显著性改善（χ2值分别为5．298、5．592、4．457，均P＜0．05），高血压患者对高血压知识、态度和行为的正确率也均有显著性改善（χ2值分别为7．871、6．970、6．856，均P＜0．01），高危妇女收缩压显著降低（t＝4．619，P＜0．01），舒张压也显著降低（t＝2．220，P＜0．05），高血压患者收缩压和舒张压均显著降低者t值分别为23．598、11．884，均P＜0．01。经过1年的规范管理，与心血管健康相关的一些生化指标也获得了改变，与规范管理前比较，高血压妇女的总胆固醇、三酰甘油、低密度脂蛋白均显著降低（t值分别为2．679、2．281、3．288，均P＜0．05），且高危妇女的总胆固醇、三酰甘油水平均显著下降（t值分别为2．039、1．981，均P＜0．05）。规范管理后患者治疗率、血压控制的优良率和控制率均有改善（χ2值分别为159．625、16．359、21．387，均P＜0．05），而不良率却显著下降（χ2＝5．641，P＜0．05）。结论社区规范管理有助于改善高血压患者的治疗和控制。
목적：분석중노년부녀고혈압사구규범화항목관리모식급기효과，위완선사구위생복무체계제공기층자료。방법선택45～63세재본중심할구학진위고혈압병（288인）급고위자（101인）위연구대상，실시유관고혈압적지식、태도화행위등기선조사，거2010중국고혈압방치지남，건립건강당안，실행분급관리，수방포괄혈압측량、건강교육화치료방안조정，재기선조사적기출상，실시위기2년적사구규범관리。결과실시규범관리후，중노년고혈압고위부녀재고혈압지식、태도화행위방면적정학솔균유현저성개선（χ2치분별위5．298、5．592、4．457，균P＜0．05），고혈압환자대고혈압지식、태도화행위적정학솔야균유현저성개선（χ2치분별위7．871、6．970、6．856，균P＜0．01），고위부녀수축압현저강저（t＝4．619，P＜0．01），서장압야현저강저（t＝2．220，P＜0．05），고혈압환자수축압화서장압균현저강저자t치분별위23．598、11．884，균P＜0．01。경과1년적규범관리，여심혈관건강상관적일사생화지표야획득료개변，여규범관리전비교，고혈압부녀적총담고순、삼선감유、저밀도지단백균현저강저（t치분별위2．679、2．281、3．288，균P＜0．05），차고위부녀적총담고순、삼선감유수평균현저하강（t치분별위2．039、1．981，균P＜0．05）。규범관리후환자치료솔、혈압공제적우량솔화공제솔균유개선（χ2치분별위159．625、16．359、21．387，균P＜0．05），이불량솔각현저하강（χ2＝5．641，P＜0．05）。결론사구규범관리유조우개선고혈압환자적치료화공제。
Objective To analyze the mode and effect of community-based standard management on middle-aged and aged women with hypertension in order to provide basic data for the improvement of community health service system .Methods A total of 389 cases, including 288 cases with hypertension and 101 high risk persons from Yonghe Community Health Service Center aged 45-63 years old, were investigated with self-designed questionnaires on knowledge , attitude and practice ( KAP) about hypertension .According to 2010 Chinese Guidelines of Hypertension Prevention and Control , health archives were established and the graded management was performed .Follow-up management involved blood pressure reading ,health education and treatment adjustment .On the basis of baseline investigation , community standard management was carried for one year .Results After standard management the correct rate of KAP of hypertension among high risk middle-aged and aged women was significantly increased (χ2 value was 5.298, 5.592 and 4.457, respectively, all P<0.05), and that among women with hypertension was also significantly increased after standard management (χ2 value was 7.871, 6.970 and 6.856, respectively, all P<0.01).The systolic pressure of high risk women was significantly decreased (t=4.619, P<0.01), and the diastolic pressure was also significantly decreased (t=2.220, P<0.05).The systolic pressure and diastolic pressure of women with hypertension were significantly decreased (t value was 23.598 and 11.884, respectively, both P<0.01).After one-year standard management , the total cholesterol, triacylglycerol and low density lipoprotein of women with hypertension were significantly decreased (t value was 2.679, 2.281 and 3.288, respectively, all P<0.05), and the total cholesterol and triacylglycerol of high risk women were also significantly decreased (t value was 2.039 and 1.981, respectively, both P<0.05).The curative rate, good rate of blood pressure control and control rate were significantly improved compared to those before management (χ2 value was 159.625, 16.359 and 21.387, respectively, all P<0.05), but the reject ratio was significantly decreased (χ2 =5.641,P <0.05).Conclusion Community-based health management is beneficial to improving the treatment and control of hypertension .