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目的分析社区高血压细节管理对社区高血压患者血压控制的效果及其影响因素,为完善社区高血压细节管理模式提供依据。方法按照入选标准,选取400例上海市枫林社区当年新发现的原发性高血压患者,随机分为干预组和对照组,每组200人。干预组采用群体健康教育和个性化指导相结合的方式进行管理,对照组采取常规的高血压分组管理。在干预前(2007年1月)和干预后(2015年1月)比较两组的血压控制情况。结果干预后,干预组的平均收缩压(SBP)和平均舒张压(DBP)较对照组分别低8.03 mmHg和6.55 mmHg,差异均有统计学意义(P<0.01)。在血压达标率、危险分层及服药依从性方面干预组均优于对照组(P值均<0.05);影响血压控制效果的主要因素为性别、体质指数、高盐膳食和吸烟。结论上海市社区高血压疾病细节管理对高血压患者的血压控制效果显著,是促进高血压患者血压稳定的有效途径。
Objective To analyze the effect of community hypertension management on the control of blood pressure in community-based hypertensive patients and its influencing factors, so as to provide the basis for improving the detail management of community hypertension. Methods According to the inclusion criteria, 400 cases of newly diagnosed essential hypertension in Fenglin Community of Shanghai were selected and randomly divided into intervention group and control group with 200 in each group. Intervention group using group health education and personalized guidance to manage a combination of control group to take conventional hypertension group management. Blood pressure control was compared between the two groups before intervention (January 2007) and after intervention (January 2015). Results After intervention, the average systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) of the intervention group were 8.03 mmHg and 6.55 mmHg lower than those of the control group respectively (all P <0.01). The intervention group was better than the control group in the compliance rate, risk stratification and medication compliance (P <0.05). The main factors affecting the blood pressure control effect were gender, body mass index, high-salt diet and smoking. Conclusion The management of detail hypertension in community in Shanghai has a significant effect on the control of blood pressure in hypertensive patients, which is an effective way to promote the blood pressure stability in patients with essential hypertension.