社区综合健康管理对老年高血压患者生活质量的影响

Effect of community comprehensive health management on quality of life in elderly hypertensive patients

目的探索江苏省南京市老年高血压患者在社区综合健康管理下的血压和生命质量变化情况。方法 2013年3~12月,按照整群随机抽样的原则,抽取南京市某社区医院管辖内老年高血压患者520例,再利用随机数字表产生随机数字将其分为对照组和管理组,对管理组老年高血压患者实施专项的社区健康管理,对照组老年高血压患者实施常规管理、不增加干预措施。对两组患者在基线、中期(6个月)和终期(18个月)共进行三次问卷调查,并用多水平模型分析生命质量变化情况。结果管理组和对照组的基线情况差异均无统计学意义(均有P>0.05)。为期18个月的干预后,管理组对比对照组,收缩压平均降低(4.74±1.69)mm Hg(t=2.801,P=0.006),舒张压平均降低(3.67±1.17)mm Hg(t=3.158,P=0.002),差异具有统计学意义;在生命质量方面,两组的视力状况(Z=-3.142,P=0.002)、牙齿情况(Z=-2.130,P=0.034)、睡眠状况(Z=-3.471,P<0.001)、心理状况(Z=-2.051,P=0.040)和总体健康情况(Z=-2.653,P=0.008)的差异有统计学意义,管理组均优于对照组;生命质量得分变化情况也优于对照组。结论社区健康管理可以改善老年高血压患者的血压状况,提高生活质量。

Objective To explore the changes of blood pressure and quality of life in elderly hypertensive patients in Nanjing under community comprehensive health management. Methods From March to December 2013, 520 elderly hypertensive patients aged over 60 years were recruited from a community hospital in Nanjing, and were divided into the control group and the management group according to the principle of simple random assignment. The management group of elderly patients with hypertension had the special community health management, but the control group of elderly patients with hypertension had no intervention measures. A total of three surveys with questionnaires were conducted at baseline, mid （at the 6 months）, and final periods （ at the 18 months）, and then used the multilevel model to analyze the change of quality of life. Results There were no significant differences in the baseline data between the management group and the control group （all P〉0. 05）. After the 18 months of intervention, when management group compared to control group, the mean reduction of systolic pressure was （4. 74± 1.69）ram Hg （t=2. 801, P=0. 006）, mean reduction of diastolic pressure was （3.67±1.17）mm Hg （t = 3. 158, P=0. 0.002）, the difference was statistically significant. In addition,the two groups had significant differences in vision situation （Z=-3. 142, P= 0.002）, teeth status （Z=-2. 130, P=0.034）, sleep status （Z=-3.471, P〈0.001）, mental status （Z=-2.051, P=0. 001） and total score of quality of life （ Z=-2. 653, P=0. 008）. All of them in management group was better than that of the control group. The change of score in quality of life of management group was also better than that of the control group. Conclusion Commu- nity health management can improve blood pressure control and the quality of life for elderly hypertensive patients.