高血压规范化管理适宜技术的应用效果评价

Effects of Appropriate Technology of Standardized Management on Hypertension

目的评价高血压管理适宜技术的应用效果,探讨高血压规范化管理的推广模式。方法按照经济、文化、卫生等基本情况从海安县多阶段分层整群随机抽取6个镇,每个镇按照随机数字表法抽取4~5个行政村,并按照诊断标准开展高血压病人筛查。按照病人入选标准,规范化管理组共入选2000名高血压病人,对照组入选1000名;规范化管理组按照方案要求开展2年的分层分级管理和健康教育,对照组按照当地常规处理。用SPSS18.0软件分析数据和评价管理效果。结果 2年后除失访和退出研究的患者,规范管理组完成管理1945人（失访率2.75%）,对照组967人（失访率3.30%）。规范管理组的高血压病人药物治疗率、非药物治疗率及两者均有的比率显著提高（由管理前的20.02%、5.01%和3.65%分别提高到管理后的85.04%、68.59%和60.23%）,且与对照组比较也显著提高。规范化管理组病人血压控制率由管理前的4.10%提高到管理后的61.03%,有显著差异;对照组病人血压控制率由原来的4.13%提高到31.02%,控制率虽有显著提高,但仅为规范化管理组的50%左右。规范化管理组的高血压病人血脂、血糖等生化指标改善和健康生活方式的形成率管理前后有显著提高,而对照组变化不大,管理组与对照组前后比较有显著差异。结论高血压规范化管理适宜技术应用效果明显,尤其在改善患者的危险因素上效果显著。

Objective To evaluate the effects of appropriate technology of standardized management on hypertension ,and to explore the promotion model for standardized management of hypertension .Methods 6 towns were selected randomly by the method of multistage stratified cluster according to the economic status ,culture and health level and so on from Hai’an County.4-5 villages were chosen by the method of random digital from each town ,and the hypertensive were screened according to the diagnostic criteria.2000 hypertensive were enrolled in the standardized management group ,and 1000 patients enrolled in the control group.Standardized management group was layered managed and took health education for 2 years.Control group was treated according to the conventional method in the locality.SPSS18.0 software was used to analyze the data and evaluate the effects.Results After 2 years ,1945 subjects in intervention group completed the criteria management （the lost rate was 2.75% ）;meanwhile ,967 ones in control group completed the task （the lost rate was 3.30% ） except those who lost and quit.The rates of medication treatment ,non-medication treatment and of both them were significantly increased （from 20.02% ,5.01% ,3.65% to 85.04% ,68.59% and 60.23% ） ,which significantly higher than that in the control group.The blood pressure control rate was significantly increased from 4.10% to 61.03% after 2-year standardized management in the standardized management group ;it was also increased from 4.13% to 31.02% in the control group , which was only half compared with the group of standard management. The biochemical criterion of blood-fat ,blood glucose ,and rates of formation of healthy lifestyle significantly increased in the standardized management group after 2 years’ management ;however ,that was nearly no change in the control group.Conclusions The effects of the appropriate technology of standardized management on hypertension were significant ,especially on the improvement of reducing risk factors.