高血压患者治疗依从性及其影响因素的纵向研究

Treatment adherence and correlated factors of patients with hypertension： a longitudinal study

目的了解高血压患者治疗依从性的状况及其影响因素。方法采用问卷调查的方法于2009年至2012年对原发性高血压患者进行2次调查，分析影响高血压患者治疗依从性的相关因素。结果参加完第1次调查的患者520例，同意并完成第2次调查的患者331例，参加第2次调查与未参加第2次调查的患者人口学特征比较，除受教育程度（Х^2=9．38）外，差异均无统计学意义。高血压患者在第2次调查时的症状发生率低于第1次，并发症的发生率也随之下降，但二者比较差异无统计学意义。高血压患者在第2次就诊时的收缩压、舒张压低于第1次，实验室检测指标（血清肌酐、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、空腹血糖、餐后血糖）在第2次调查时呈现下降趋势，但是差异均无统计学意义。在第2次调查时的治疗依从性、自我效能、社会支持、生命质量方面得分均有明显的提高，2次调查得分之间呈显著正相关，相关性具有统计学意义。多元线性回归分析显示第1次测量时患者的依从性行为、社会支持、受教育程度、患病时间进入了回归方程，解释了总变异的26％，其中依从性行为、社会支持、受教育程度、患病时间分别解释了变异的15％、7％、3％和1％。结论经过1年的随访提高了高血压患者的依从性行为，医务人员应重视患者在疾病初始阶段的治疗依从性。根据患者个体与疾病特征以及影响依从性的因素，针对性地采取个体化干预措施，对其进行血压控制，改变不良生活方式。

Objective This article aimed to investigate the treatment adherence of patients with hypertension and examine determinants of adherence. Methods A longitudinal design was adopted to test the treatment adherence and correlated factors of patients with hypertension twice from 2009 to 2012. The influencing factors of treatment adherence in patients with hypertension were analyzed. Results A total of 520 patients finished the first investigation, and 331 patients completed the second investigation. The comparison of demographic characteristics between patients who participated the second investigation or not showed no significant difference except for the education degree 52=9.38）. The incidences of symptoms and complications, systolic blood pressure and diastolic blood pressure of hypertensive patients and the laboratory indexes such as serum creatinine （SCr）, total cholesterol （TC）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, fasting blood-glucose and postprandial blood sugar in the second investigation were lower than those of the first investigation, but the difference showed no statistical significance. The scores of treatment adherence, self-efficacy, social support, quality of life were higher in the second investigation than those of the first investigation. The multiple regression analysis found that treatment adherence, social support, education degree and duration of disease course were significant predictors in the first investigation entered the equation, accounting for 26% of the total variance, among which treatment adherence explained 15% of the variance, social support 7%, education degree 3% and duration of disease course 1%. Conclusions The treatment adherence of hypertensive patients improved over one year follow-up. Heahhcare providers should pay attention to adherence behavior at initial phase of disease development, and effective strategies targeted patients at risk are suggested to be necessary and should be designed according to the factors affecting adherence.