基层医疗机构缺血性脑卒中患者的高血压防治现况

Status of Management of Hypertension for Patients with Ischemic Stroke in Basic Medical Institutions

目的评价北京市城区基层医疗单位就诊的缺血性脑卒中患者高血压防治现况。方法2004年12月—2005年11月在北京市5个区各选一家二级医院,对在上述医院及其所属的社区卫生服务中心(站)就诊的999例缺血性脑卒中患者进行问卷调查,内容包括脑卒中患者的基本情况、现病史、既往史和个人史。结果999例缺血性脑卒中患者中高血压患病率为79.1%。高血压患者的高血压知晓率、治疗率和控制率分别是93.3%、84.3%和40.3%。高血压患病率随文化程度的升高而降低(P<0.01);脑卒中发作2次的患者高血压患病率与发作1次的患者比较,差异有统计学意义(P=0.008);伴有心脏病、糖尿病、血脂代谢异常、超重或肥胖的脑卒中患者高血压患病率与无上述因素者比较,差异有统计学意义(P<0.05)。666例接受药物治疗的患者中,45.6%(304例)使用复方类降压药(单用复方类降压药者占47.7%,联合用药者占52.3%);54.4%(362例)使用非复方类降压药(单一用药者占52.2%,联合用药者占47.8%);最常见的组合为钙拮抗剂和β-受体阻滞剂、β-受体阻滞剂和血管紧张素转换酶抑制剂。结论在北京市基层医疗机构就诊的缺血性脑卒中患者高血压患病率高达79.1%,高血压的控制率还不理想,高血压药物治疗还欠规范,提示基层医疗机构医务人员的高血压防治知识亟待加强与规范。

Objective To assess the status of prevention and treatment hypertension for among ischemic stroke survivors in urban medical institutions of Beijing. Methods A questionnaire survey, the contents of which included the basic conditions, present illness history, past history and personal history, was conducted among 999 ischemic stroke survivors from 5 second grade hospitals and their affiliated community health service centers in urban areas of Beijing from December 2004 to November 2005. Results The prevalence of hypertension was 79.1% among the 999 patients. The rates of awareness, treatment and control of hypertension were 93.3% , 84. 3% and 40. 3% respectively. The prevalence of hypertension was increased along with the decrease of educated degree （ P 〈 0. 01 ） ; the morbidity was higher in patients with two times stroke than in those with stroke once, with a significant difference （ P = 0. 008 ） ; and there was significant difference in morbidity of hypertension between the patients with heart disease, diabetes mellitus, fat metabolite disturbance and obesity and those without any of these condition （ P 〈 0.05 ）. Among 666 hypertensives who were under anti - hypertension medication, anti - hypertension drug - channel blocker and ACEI Among 666 hypertensives who were under anti - hypertension medication, 45.6% （304） took compound anti - hypertensives （47.7% of them took it only and the rest 52. 3% took it with other kinds of anti - hypertensives） ; 54.4% （362） took non -compound anti -hypertensives （single medication accounting for 52. 2% and combined medications for 47.8% ） ; the commonest combinations were Ca^2＋ -channel blocker plus β adrenoceptor and β adrenoeeptor plus angiotensin converting enzyme inhibitor （ACEI）. Conclusion The prevalence of hypertension is up to 79. 1% among the ischemic stroke survivors who get their medical service in basic medical institutions of urban areas of Beijing. The control rate of hypertension is unsatisfactory; the usage of anti - hypertensives is under standard. This suggests the preventing and treating knowledge of hypertension for medical professionals in the basic institutions is urgently required.