医院与社区综合干预模式对老年高血压病患者尿肌酐白蛋白比值及预后影响研究

Study on the effect of comprehensive intervention model of hospital and community on UACR and prognosis of elderly patients with hypertension

目的:探讨医院与社区综合干预模式对老年高血压病患者尿白蛋白肌酐比值(UACR)及预后的影响。方法:以某社区老年高血压病患者为研究对象,随机分为对照组与观察组各120例。两组患者研究期间均由我院专科医生制定及调整治疗方案,所有患者每月门诊随诊1次;观察组同时由社区医师每周随访1次。随访24个月后,比较两组患者血压达标率、UACR、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、室间隔厚度(IVS)、左室射血分数(LVEF)、主要不良心脑血管事件(MACCE)及再住院率。结果:随访12、18、24个月时,观察组的血压达标率分别为60.83%、72.16%、92.17%,明显高于对照组35.00%、54.87%、72.19%,差异均具有统计学意义(P<0.05);随访12及24个月时,观察组UACR显著低于对照组,随访24个月时对照组UACR转阳率(18.30%)明显高于观察组(9.17%),差异均具有显著性(P<0.05)。随访12及24个月时,观察组LVESV、LVEDV及LVEF水平显著优于对照组;随访24个月时,观察组的IVS水平显著低于对照组,差异具有统计学意义(P<0.05);随访24个月时,观察组MACCE事件发生率及再入院率显著低于对照组,其中脑血管不良事件发生率及心血管不良事件发生率均显著低于对照组,差异均具有显著性(P<0.05)。结论:医院与社区综合干预模式可显著延缓老年高血压病患者的靶器官损害,改善老年高血压病患者的预后,是一种值得临床借鉴推广的老年高血压病防治模式。

Objective：To explore the effect of comprehensive intervention on the prognosis of elderly patients with hypertension.Method：The elderly patients with hypertension were randomly divided into control group and observation group with 120 cases in each group.During the study period,all patients were followed up 1times per month by our hospital specialist,while the observation group was followed up by the community physician for a period of 1week.After 24 months of follow-up,compared with the UACR,the standard rate of blood pressure and renal function,left ventricular end systolic volume（LVESV）,left ventricular end diastolic volume（LVEDV）,interventricular septum（IVS）,left ventricular ejection fraction（LVEF）and major adverse cardiovascular and cerebrovascular events（MACCE）and the rate of hospitalization in two groups.Result：During the follow-up of 12,18,and 24 months,the blood pressure compliance rate of the observation group were 60.83%,72.16%,and 92.17%respectively,and higher than the control group 35%,54.87%,72.19%significantly.The difference was significant statistically（P0.05）.After 12 and 24months of follow-up,the UACR values of the observation group were lower than those in the control group significantly.After 24 months of follow-up,the UACR conversion rate（18.3%）in the control group was significantly higher than that in the observation group（9.17%）,and the difference was significant（P0.05）.After 12 and 24months of follow-up,the levels of LVESV,LVEDV and LVEF in the observation group were significantly better than those in the control group,and the level of IVS in the observation group was significantly lower than that in the control group after the follow-up of 24 months.The difference was statistically significant（P 0.05）;After 24 months of follow-up,the incidence rate of MACCE and readmission rate in observation group was significantly lower than the control group.The incidence of cerebrovascular adverse events and adverse cardiovascular events were significantly lower than the control group,and the difference was significant（P0.05）.Conclusion：The hospital and community comprehensive intervention can significantly reduce target organ damage and improve the prognosis in elderly hypertensive patients.