家庭医生签约对社区高血压合并慢性心功能不全患者的影响

Effect of family doctor signing on community hypertension patients with chronic heart failure

目的探讨家庭医生签约模式对社区高血压合并慢性心功能不全患者的影响。方法选取2016年1—12月收治的高血压合并慢性心功能不全的患者94例,采用家庭医生签约模式进行管理,收集患者临床资料,随访1年,记录ACEI/ARB,β受体阻滞剂使用情况、血压情况、心功能。结果签约1年后ACEI/ARB、β受体阻滞剂、ACEI/ARB+β受体阻滞剂使用率均升高(均P<0.001);签约一年后血压达标率(100%)高于签约时(92.55%)(P<0.001);6MWT中,签约前后150~425 m、426~550 m例数比较差异有统计学意义(均P<0.05);心功能分级中,Ⅰ级、Ⅲ级例数比较差异有统计学意义(均P<0.05),签约1年后静息心率低于签约时(P=0.03)。结论家庭医生签约模式应用于社区高血压合并慢性心功能不全患者可有效提高血压控制率、合理用药率,改善患者活动耐量及心功能。

Objective To explore the influence of family doctor contract mode on community hypertension patients with chronic heart failure.Methods A total of 94 hypertension complicated with chronic heart failure treated from January to December in 2016 were selected.Using the family doctor contract mode to manage,the patient＇s clinical data were collected for 1 year.The usage of ACEI/ARB, beta blocker, blood pressure and cardiac function were recorded.Results After 1 year＇s signing up, the utilization rate of ACEI/ARB, beta blocker and ACEI/ARB＋ beta blocker were increased（all P〈0.001）.The rate of blood pressure reaching the standard（100%） was higher than that of the contract（92.55%）（P〈0.001）.In 6 MWT, there were statistically significant differences in the number of cases between 150-425 m and 426-550 m before and after signing（all P〈0.05）.In cardiac function classification, there was a significant difference in the number of cases between grade Ⅰ and Ⅲ（all P〈0.05）, and the resting heart rate of 1 year after signing the contract was lower than that at signing time（P=0.03）.Conclusion The application of family doctor signing mode to patients with hypertension and chronic cardiac insufficiency can effectively improve the control rate of blood pressure, the rational drug use rate, and improve the patient＇s activity tolerance and heart function.