中西医结合药物疗法联合个性化健康管理社区干预高血压随机平行对照研究

Drug Therapy combined with Individualized Health Management of Community Hypertension Intervention Randomized Controlled Study of combined Traditional Chinese and Western Medicine

[目的]观察中西医结合药物疗法联合个性化健康管理治疗高血压疗效。[方法]使用随机平行对照方法,将110例住院及门诊患者按就诊顺序号抽签方法简单随机分为两组。对照组55例中西医结合治疗,血管紧张素转换酶抑制剂、钙拮抗剂、血管扩张剂、交感神经抑制荆、利尿剂等,单独用药或联合用药,二联或三联,同类降压药不联合使用;辨证分型:冲任失调,二仙汤(仙茅、当归、巴戟天、仙灵脾各9g,黄柏、知母各4.5g),阳虚加枸杞、菊花;瘀血阻滞,血府逐瘀汤(桃仁12g,红花、生地黄、川芎、当归、赤芍各10g,牛膝9g,枳壳、桔梗各6g,柴胡、甘草各3g),胸痛加青皮,脘腹疼痛加香附、乳香,肝胁胀痛加土鳖虫、郁金、大黄;肝阳上亢,天麻钩藤饮(天麻9g,钩藤12g,石决明18g,川牛膝12g,栀子、杜仲、桑寄生各10g,黄芩、益母草、朱茯神各9g);肝肾阴虚,杞菊地黄丸(枸杞、菊花各10g,熟地黄、山药各12g,酒萸肉10g,泽泻、牡丹皮各9g,茯苓6g);痰浊中阻,半夏白术天麻汤(半夏9g,蔓荆子、白术、茯苓、天麻和陈皮各6g,炙甘草3g,大枣3枚,生姜片2片),痰多加桂枝、泽泻,肝阳亢盛加钩藤、赭石;阴阳两虚,金匮肾气丸(地黄15g,茯苓、山药、泽泻、山茱萸、牛膝各12g,附子10g,车前子9g,牡丹皮6g,蜂蜜30g);按摩:合谷、曲池、太冲、内关、太溪等。治疗组55例个性化健康管理:①健康教育:定期举行讲座和交流会等,发放健康宣传手册、张贴海报,讲解高血压病因、症状、检查、诊断、治疗方法、治疗作用、不良反应、并发症;②监测随访:建立病历档案,定期询问病情、检测血压,记录每次检测结果,根据病情指导药,高龄或行动不便者上门服务;③饮食指导:低盐饮食,多食富含优质蛋白、高维生素、高钾和具有防治高血压的食物(菌类、食物的根茎、海藻类、新鲜蔬菜水果、豆制品等),忌食高脂肪食物、甜食、烟酒,如肌肉、羊肉、鸡皮、熏肉、猪肝等;(④运动指导:鼓励多做有氧运动;⑤用药指导:严格遵医嘱用药,不擅自增减;中西医结合治疗同对照组。连续治疗1个月为1疗程。观测临床症状、血压、健康管理评分、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组显效37例,有效14例,无效4例,总有效率92.73%。对照组显效25例,有效18例,无效12例,总有效率78.18%。治疗组疗效优于对照组(P<0.05)。健康管理评分两组均有改善(P<0.01),治疗组优于对照组(P<0.05)。[结论]中西医结合药物疗法联合个性化健康管理治疗高血压,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the curative effect of combined drug therapy combined with personalized health management of traditional Chinese medicine and western medicine treatment of hypertension. [Method] Using random parallel control method,110 cases of inpatient and outpatient treatment order, draw simple methods were randomly divided into two groups.The control group of 55 cases treated with western medicine, angiotensin-converting enzyme inhibitors,calcium antagonists, vasodilators, sympathetic inhibitors and diuretics, used alone or in combination, two or three, the combined use of antihypertensive drugs is similar;syndrome differentiation：Chongren disorder,erxian decoction （Radix Angelicae sinensis, Rhizoma curculiginis,Morinda officinalis, Herba Epimedii 9g,phellodendron bark, Anemarrhena 4.5g）,Yang and medlar, chrysanthemum;blood stasis,Xuefuzhuyu Decoction （peach 12g,safflower, radix rehmanniae,Ligustieum chuanxiong and Angelica sinensis and Radix Paeoniae Rubra 10g,Achyranthes 9g,Fructus aurantii,Platycodon 6g, Chai Hu, licorice 3g）, chest pain with green skin,abdominal pain,liver flavored with frankincense, and coerces pain wood louse, turmeric, rhubarb; liver yang hyperactivity,tzk （Gastrodia 9g,Uncaria 12g,abalone 18G,Cyathula 12g,gardenia, eucommia, mistletoe 10g, baicalin, oriental waterplantain rhizome,tangerine peel,motherwort,Zhu Poria each 9g）; liver and kidney yin deficiency, Qiju Dihuang Pill （Chinese wolfberry,chrysanthemum 10g,Radix Rehmanniae Preparata,Rhizoma Dioscoreae 12g,liquor Comus officinalis 10g,Rhizoma alismatis,peony peel 9g Poria 6g）;phlegm turbidity of resistance, Banxia Baizhu Tianma Decoction （pinellia tuber 9g,Vitex trifolia, white atractylodes rhizome,Poria cocos, hemp and the 6G licorice 3G,jujube 3 pieces,ginger tablets 2 tablets）, Ta Kakeiji liver yang hyperactivity of Sheng with uncaria, ochre; Yin and yang deficiency, Jingui Shenqi Pill （Rehmannia glutinosa 15g,tuckahoe, yam, Oriental waterplantain rhizome, dogwood and Achyranthes root 12g, Radix Aconiti Lateralis Preparata 10g,Plantago 9g,tree peony bark 6G,honey 30g）;massage Hegu Quchi, Taiehong, Neiguan, too Creek. The treatment group of 55 cases of personalized health management：Health Education： regular lectures and exchanges, health brochures, posters, to explain the etiology of hypertension, symptoms, examination, diagnosis and treatment methods, treatment effects,adverse reactions and complications; the follow-up monitoring： the establishment of medical records,regular inquiry, blood pressure every time, record test results, according to the condition of the guidance of drug,elderly or disabled door-to-door services; the guidance of diet： low salt diet, eat rich high quality protein, vitamins, and Gao Jia has the prevention of high blood pressure （food, food fungus rhizome, seaweed, fresh fruits and vegetables,bean products, etc.） eat high fat foods, sweets,alcohol and tobacco, such as muscle, lamb, chicken, bacon and pork;the motion guide： encourage do more aerobic exercise and medication.Guide：strictly prescribed medication,is not allowed to increase or decrease; combination of traditional Chinese and western medicine treatment with the control group. 1 months of continuous treatment for 1 courses, observation of clinical symptoms, blood pressure, health management score, adverse reaction.Continuous 3 courses of treatment,the curative effect.37 cases of treatment group [Result] 14 cases were effective,4 cases ineffective, the total efficiency of 92.73%.The control group was 25 cases,18 cases were effective, 12 cases ineffective, the total efficiency of 78.18%. The treatment group than the control group （P〈0.05）. Health management scores of the two groups were improved （P〈0.01）,the treatment group than the control group （P〈0.05）. [Conclusion] Traditional Chinese medicine and western medicine combined with drug therapy combined with personalized health management for the treatment of hypertension, the curative effect is satisfied, no serious adverse reactions,worthy of promotion.