绝经期女性健康管理模式的实践与探讨

Practice and Analysis on Health Management for Postmenopausal Women

目的：探讨建立以集体宣教、一对一咨询等综合保健措施为基础,激素替代疗法（hormone replacement therapy,HRT）为中心的规范化绝经期健康管理模式。方法：选择笔者所在医院妇科门诊2013年3月-2014年2月收治的40~59岁绝经期妇女作为研究对象,建立电子健康档案,进行集体宣教、健康指导、心理辅导等综合健康干预措施;一对一咨询建立个体化治疗方案进一步分为三个亚组：激素替代疗法组（HRT组）、黑升麻提取物治疗组（莉芙敏组）、中药治疗组（泰坤胶囊组）,干预后12个月随诊,对健康管理效果进行评价。结果：本研究共103例患者完成了干预研究,完成率93.64%;患者年龄40~59岁,平均（49.40±4.08）岁。其中HRT组54例、莉芙敏组26例、泰坤胶囊组23例;三组患者年龄、体重、婚姻状况、文化程度、职业分布、平均月收入比较差异均无统计学意义（P〉0.05）。干预前,除血糖值在三组之间存在差异（泰坤胶囊组高于HRT组,P=0.003）外,三组患者的总胆固醇、血压、Kupperman评分和骨密度值比较,差异均无统计学意义（P〉0.05）。干预后,HRT组的总胆固醇测量值低于泰坤胶囊组（P=0.001）;HRT组的Kupperman评分分别低于莉芙敏组（P〈0.001）和泰坤胶囊组（P〈0.001）;HRT组的骨密度值分别高于莉芙敏组（P=0.042）和泰坤胶囊组（P=0.004）。HRT组患者干预后的总胆固醇测定值（P=0.047）、Kupperman评分（P〈0.001）均明显低于干预前;莉芙敏组患者干预后Kupperman评分均明显低于干预前,差异有统计学意义（P=0.002）;泰坤胶囊组患者干预后Kupperman评分均明显低于干预前,差异有统计学意义（P=0.001）。结论：以HRT治疗为中心的绝经期管理模式,可以有效缓解绝经期症状,改善患者健康水平,值得临床推广。

Objective： To establish standardization postmenopausal women health management by one to one consultation integrated health based measures and hormone replacement therapy.Method： Postmenopausal women from March 2013 to February 2014 in our hospital were selected as the research subjects.Established electronic health records, collective education, health guidance, counseling and other comprehensive health interventions were used.One to one consultation to establish individualized treatment plan, and further divided postmenopausal women into three subgroups： hormone replacement therapy group, black cohosh group, TCM treatment group, follow-up in 12 month to evaluate the effect of health management.Result： In this study, 103 patients completed the intervention study, the completion rate was 93.64%.Patients aged 40-59 years old, average age was （ 49.40 ＋ 4.08 ） years oId.HRT group （ 54 cases ）, black cohosh extract group （ 26 cases ）, Chinese medicine group （23 cases ） .Patients in the three groups in age, weight, marital status, education, occupation distribution, the average monthly income differences had no statistical significance （ P〉0.05 ） .Before intervention, there were no significant difference in blood lipid, blood pressure, Kupperman score and bone mineral density between three groups （ P〉0.05 ）, except for blood glucose （ P=0.003 ） .After the intervention, the measurement of plasma lipids in the HRT group value lower than that of traditional Chinese medicine group （ P=0.001 ） .Kupperman scores in HRT group were lower than those of black cohosh extract group （ P〈0.001 ） and Chinese medicine group （ P〈0.001 ） .Bone mineral density in HRT group values were higher than those of black cohosh extract group （ P=0.042 ） and Chinese medicine group （ P=0.004 ） .Patients in HRT group dry prognosis of lipids measured values （ P=0.047 ） and Kupperman score （ P〈0.001 ） were significantly lower than those before intervention.Black cohosh extract group intervention in patients with Kupperman scores were significantly lower than those before intervention （ P=0.002 ） .Chinese medicine group were dry prognosis Kupperman scores were significantly lower than those before intervention （P=0.001） .Conclusion： The menopause management mode of HRT treatment as the center, can effectively alleviate menopausal symptoms, improve patient health level, it is worth of clinical promotion.