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目的:探讨医院与社区综合干预模式对老年高血压病患者尿白蛋白肌酐比值(UACR)及预后的影响。方法:以某社区老年高血压病患者为研究对象,随机分为对照组与观察组各120例。两组患者研究期间均由我院专科医生制定及调整治疗方案,所有患者每月门诊随诊1次;观察组同时由社区医师每周随访1次。随访24个月后,比较两组患者血压达标率、UACR、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、室间隔厚度(IVS)、左室射血分数(LVEF)、主要不良心脑血管事件(MACCE)及再住院率。结果:随访12、18、24个月时,观察组的血压达标率分别为60.83%、72.16%、92.17%,明显高于对照组35.00%、54.87%、72.19%,差异均具有统计学意义(P<0.05);随访12及24个月时,观察组UACR显著低于对照组,随访24个月时对照组UACR转阳率(18.30%)明显高于观察组(9.17%),差异均具有显著性(P<0.05)。随访12及24个月时,观察组LVESV、LVEDV及LVEF水平显著优于对照组;随访24个月时,观察组的IVS水平显著低于对照组,差异具有统计学意义(P<0.05);随访24个月时,观察组MACCE事件发生率及再入院率显著低于对照组,其中脑血管不良事件发生率及心血管不良事件发生率均显著低于对照组,差异均具有显著性(P<0.05)。结论:医院与社区综合干预模式可显著延缓老年高血压病患者的靶器官损害,改善老年高血压病患者的预后,是一种值得临床借鉴推广的老年高血压病防治模式。
Objective: To investigate the effect of integrated hospital and community intervention on urinary albumin creatinine ratio (UACR) and prognosis in elderly patients with essential hypertension. Methods: A total of 120 elderly patients with hypertension in a community were randomly divided into control group and observation group. During the study period, both groups of patients were drawn up and adjusted their treatment plan by specialists in our hospital. All the patients were followed up once a month. The observation group was also followed up weekly by community physicians. After 24 months of follow-up, the blood pressure compliance rate, UACR, LVESV, LVEDV, IVS, LVEF, Major adverse cardiovascular and cerebrovascular events (MACCE) and rehospitalization rates. Results: At the follow-up of 12, 18 and 24 months, the blood pressure compliance rates in the observation group were 60.83%, 72.16% and 92.17%, respectively, which were significantly higher than those in the control group 35.00%, 54.87% and 72.19% P <0.05). UACR in observation group was significantly lower than that in control group at 12 and 24 months after follow-up. The positive rate of UACR in control group (18.30%) was significantly higher than that of observation group (9.17%) at 24 months of follow-up. Significance (P <0.05). The levels of LVESV, LVEDV and LVEF in the observation group were significantly better than those in the control group at 12 and 24 months of follow - up. The levels of IVS in the observation group were significantly lower than those in the control group at 24 months of follow - up (P <0.05). At 24 months of follow-up, the incidence of MACCE events and readmission rates in the observation group were significantly lower than those in the control group. Incidence of cerebrovascular adverse events and cardiovascular adverse events were significantly lower in the observation group than in the control group (P <0.05). Conclusion: The integrated hospital and community intervention model can significantly delay target organ damage in elderly hypertensive patients and improve the prognosis of elderly hypertensive patients. It is a model of prevention and treatment of senile hypertension with clinical reference.