我国高血压双向转诊标准的研究现状

Hypertension Bidirectional Referral Criteria in China:a Literature Analysis

目的了解我国高血压双向转诊标准的研究现状。方法于2017年6月20—30日,以中国知网(CNKI)、万方数据知识服务平台为主,辅以其他数据库和网站,进行计算机检索,以获取与高血压双向转诊标准有关的文献。将纳入文献分为指南类和论文类,对不同时间发布的指南类文献进行对比分析,以了解转诊标准指南的发展情况;对论文类文献中采用的转诊标准进行汇总分析,以了解转诊标准的应用现状。结果共纳入符合标准的指南类文献3篇、论文类文献8篇。3篇指南分别为2009年基层版《中国高血压防治指南》(《2009版指南》)、2014年修订版《中国高血压基层管理指南》(《2014版指南》)、《国家基层高血压防治管理指南2017》(《2017版指南》)。其中,《2009版指南》与《2014版指南》中的高血压双向转诊标准一致,《2017版指南》对前2版指南中的部分条目进行了量化和细化、增加社区卫生服务机构上转的急诊转诊标准、删除上级医院的转回标准。指南类文献和论文类文献均未给出转诊标准的拟定依据,论文类文献未采用指南中发布的转诊标准且采用的转诊标准不统一,论文类文献中缺乏专门针对转诊标准拟定和应用的研究且未重视对转诊标准的评价。结论指南中发布的高血压双向转诊标准尚未得到充分认可,目前针对高血压双向转诊标准的研究匮乏,建议拟定循证化、系统化、可操作性强的双向转诊标准,以保证分级诊疗工作的顺利推行。

ObjectiveTo study the research status of hypertension bidirectional referral criteria in China.MethodsFrom June 20th to 30th,2017,we searched CNKI and Wanfang Data Knowledge Service Platform,and other electronic databases and websites for documents about hypertension bidirectional referral criteria in China.The included documents were divided to guidelines and research articles.We compared the guidelines by time of publishing for exploring the development of hypertension referral criteria in guidelines,and performed a summary analysis of the hypertension referral criteria in articles for estimating the application of such criteria.ResultsA total of three guidelines and eight articles were included.The three guidelines are 2009 Guidelines for Primary Prevention and Management of Hypertension in China（2009 guidelines）,2014 Guidelines for Primary Prevention and Management of Hypertension in China（Revised Edition）（2014 revised guidelines）,and 2017 Guidelines for Primary Prevention and Management of Hypertension in China（2017 guidelines）.The hypertension bidirectional referral criteria contained in 2009 Guidelines and 2014 Revised Guidelines are consistent.In the 2017 guidelines,some items of the hypertension bidirectional referral criteria in these two guidelines were quantified and subdivided,and the acute upward referral criteria for hypertension were added,the downward referral criteria for hypertension were deleted.Neither guidelines nor research articles provided the evidence for the formulation of referral criteria.No articles used the same referral criteria and applied the referral criteria contained in the three above-mentioned guidelines.Moreover,no articles paid attention to the evaluation of such criteria,and specifically studied the development and application of such criteria.ConclusionThe hypertension bidirectional referral criteria contained in the three guidelines have not been fully recognized.Furthermore,there is lack of studies specifically targeting such criteria.In view of this,it is suggested to formulate evidence-based,systematic and easy-to-use hypertension bidirectional referral criteria,to ensure the smooth implementation of the hierarchical medical system.