上海社区高血压疾病细节管理对高血压患者膳食行为的影响研究

Influence of Disease Details Management Program for Hypertension on Dietary Behavior of Patients with Hypertension in Shanghai Community

目的评估上海社区高血压疾病细节管理对高血压患者膳食行为的影响。方法在上海市4个中心城区的社区卫生服务中心选取1 429例符合入选标准的高血压患者,按2∶1的比例随机分为细节管理组919例和日常管理组473例。对细节管理组患者进行为期一年的疾病细节管理和干预,日常管理组只进行常规的管理。在基线和末期分别以问卷形式对所有患者进行膳食行为调查。结果干预后,细节管理组在进食粗粮、牛奶及奶制品、海产品、菌类食品和白肉类食品等膳食保护性因素,以及饮酒习惯、外出就餐或选择外卖、进食肥肉和油煎炸食品、调味品的摄入等非膳食保护性因素方面均有显著的改善,差异有统计学意义(P<0.05);日常管理组没有明显改善。细节管理组中血压达标者较未达标者在进餐规律、饮酒习惯、选择零食、进食水果及新鲜蔬菜和海产品方面有较好的膳食行为,差异有统计学意义(P<0.05)。结论上海社区高血压疾病细节管理有助于改善高血压患者的膳食行为,是促进高血压患者合理膳食的有效途径。

Objective To evaluate the influence of disease details management program（DMaP） for hypertension on dietary behavior of patients with hypertension in Shanghai community. Methods Totally 1 429 patients with hypertension according to the selection criteria from 4 community health service centers in downtown of Shanghai were enrolled,and randomly assigned to the intervention group（n=919） and the usual group（n=473） in a ratio of 2∶1.One year disease management and interventions for the intervention group were implemented.Dietary behaviors of all patients were investigated with questionnaires before and after the intervention. Results After the intervention,the subjects in the intervention group had significant improvement in both dietary protective factors such as taking roughage,milk and milk products,seafood,mushrooms and white meats,and dietary non-protective factors such as drinking,dining out or takeaway,taking fat meat or fried foods,and condiments intake（P0.05）;but the subjects in the usual group had no significant improvement.The patients whose blood pressure was up to the standard had better dietary behavior in regular dinning,drinking,taking snacks,fruits and vegetables,and seafood than those whose blood pressure was not up to the standard in the intervention group（P0.05）. Conclusion DMaP is benefit to improve dietary behavior of patients with hypertension,and it is an effective approach to promote patients with hypertension to have a rational diet.