社区-基层医院双向管理模式对高血压患者的干预效果评价

Effect of the two-way management model of community hospitals on medical intervention of hypertension

目的评价社区-基层医院双向管理模式对高血压患者的干预效果。方法选择2012年8月至2013年8月保定市徐水区吉安、滨河小区内常住人口中480例高血压患者作为研究对象。依据信封法随机分为观察组与对照组,各240例。对照组患者采用一般管理,观察组患者采用社区-基层医院双向管理模式,指导血压控制及危险因素干预。管理随访3年,分析干预前后患者的高血压知晓率、用药依从性、血压控制达标率的变化;评估2组患者治疗前后左心房内径、室间隔厚度、二尖瓣舒张早期血流速度峰值与舒张晚期血流速度峰值(E/A)比值的改善以及血清C反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)的变化;记录3年内各组心脑血管事件发生率。结果干预后2组高血压知晓率、用药依从性、血压控制达标率均较治疗前提高,且观察组高于对照组[98.3%(236/240)比50.4%(89/240)、69.6%(167/240)比19.2%(46/240)、55.8%(134/240)比12.1%(29/240)],差异均有统计学意义(均P<0.01)。干预后,观察组左心房内径和室间隔厚度小于、E/A比值大于对照组,差异均有统计学意义(均P<0.05)。观察组患者干预后CRP、NLR较干预前下降,并低于对照组[(8.8±3.8)mg/L比(12.8±1.2)、(11.6±3.8)mg/L,(1.69±0.25)比(2.87±0.24)、(2.71±0.33)],差异均有统计学意义(均P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论基于社区-基层医院双向管理模式可以对社区高血压病患者实施有效干预管理。干预后高血压病相关靶器官损害减轻,心脑血管事件发生率明显下降。

ObjectiveTo evaluate the effect of the two-way management model of community hospitals on medical intervention of hypertension. MethodsTotally 480 hypertensive patients were enrolled from August 2012 to August 2013 at Ji′an and Binhe community of Xushui District, Baoding. The patients were randomly divided into observation group and control group, with 240 cases in each group. The control group was treated with general management; the observation group adopted the two-way management model of community hospitals to guide the treatment of hypertension for 3 years. Awareness of hypertension, medication compliance and blood pressure control effect were assessed before and after intervention; left atrial diameter, interventricular septal thickness, the ratio of early diastolic peak velocity to late diastolic peak velocity of mitral valve（E/A）, serum C-reactive protein（CRP） level and neutrophil/lymphocyte ratio（NLR） were analyzed before and after intervention; cardiovascular and cerebrovascular events were observed. ResultsAfter intervention, hypertension awareness rate, compliance rate and blood pressure control rate were significantly improved compared to those before intervention; hypertension awareness rate, compliance rate and blood pressure control rate in observation group were significantly higher than those in control group[98.3%（236/240） vs 50.4%（89/240）, 69.6%（167/240） vs 19.2%（46/240）, 55.8%（134/240） vs 12.1%（29/240）]（P〈0.01）. Left atrial diameter and interventricular septal thickness were significantly lower and E/A ratio was significantly higher in observation group than those in control group（P〈0.05）. CRP level and NLR after intervention in observation group were significantly lower than those before intervention and those in control group[（8.8±3.8）mg/L vs （12.8±1.2）,（11.6±3.8）mg/L; （1.69±0.25） vs （2.87±0.24）,（2.71±0.33）]（P〈0.05）. Incidence of complications in observation group was significantly lower than that in control group（P〈0.05）. ConclusionHypertension intervention based on the two-way management model of community hospitals is effective in amelliorating organ damage and reducing adverse cardio-cerebrovascular events.