基层医院高血压患者的药物治疗和血压控制情况调查分析

Investigation and analysis of drug treatment and blood pressure control in hypertensive patients in primary hospital

目的了解基层医院对高血压患者治疗的规范性和有效性。方法对北京市大兴区长子营镇中心卫生院于2013年1月~2015年12月间,604例高血压患者降压药物使用及血压控制情况进行回顾性分析。降压药物分三类:推荐制剂、传统制剂、中药制剂。推荐制剂即《中国高血压基层管理指南》推荐降压药:血管紧张素转换酶抑制剂(ACEI)、血管紧张素II受体拮抗剂(ARB)、β受体阻滞剂(βRB)、钙通道阻滞剂(CCB)和利尿剂(HCTZ);传统制剂:降压0号、复方利血平等;中药制剂:清肝降压胶囊、牛黄降压胶囊等。平均治疗时间为12.31±5.54 d,治疗后连续3 d血压≤140/90mm Hg为血压达标(1 mm Hg=0.133k Pa);达标率=达标患者数/治疗人数×100%。结果 604例患者年龄在40~96岁之间,平均(63.44±10.12)岁;其中男性259例,女性345例;平均高血压病程为8.5±8.2年;住院时限为10~20 d,治疗后血压不同程度降低,收缩压从入院时的151.9±15.6 mm Hg,到治疗后的128.5±8.0 mm Hg;舒张压从91.7±9.8 mm Hg降到79.6±4.9 mm Hg。总体达标率为98.5%,高血压1~3级患者达标率分别为100%,99.4%,97.82%。在药物的使用方面563例选择推荐制剂占93.2%,31例使用传统制剂+推荐制剂占5.1%,10例使用中药制剂+推荐制剂占1.6%。推荐制剂使用中,单种制剂、两种制剂和三种制剂分别为54.88%,40.6%和4.4%。单种推荐制剂使用中67.6.1%为CCB,两种制剂联合使用者86.4%为CCB+ACEI/ARB。三种制剂联合使用中68.0%为ACEI+ARB+βRB,4%为CCB+ACEI+ARB。结论基层医院住院患者高血压治疗总体规范,达标率高达98%以上;93%以上的患者使用了推荐制剂,单一和二联制剂使用规范,三种制剂的联合用药的选择上存在作用机制相同的药物重复使用,有一定局限性,可能是少数患者血压不达标的原因。

Objective To investigate the normative and effective treatment of patients with essential hypertension in primary hospitals. Methods A retrospective analysis was conducted on the use of antihypertensive drugs and blood pressure control in 604 hypertensive patients from January 2013 to December 2015.Antihypertensive drugs are divided into three categories: recommended preparations, traditional preparations,traditional Chinese medicine preparations. Recommended agents include angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), beta blockers (βRB), calcium channel blockers (CCB) and diuretics (HCTZ); Traditional preparations include: antihypertensive 0, compound reserpine equality; traditional Chinese medicine preparations include: Qinggan Jiangya capsule, Niuhuang Jiangya capsules and so on. The average treatment time was 12.31±5.54 days, after treatment for three consecutive days blood pressure≤140/90 mmHg for blood pressure standards. The average treatment time was 12.31±5.54 days. The blood pressure was considered well controlled if the blood pressure≤140/90 mmHg for three consecutive days after treatment. Compliance rate =number of patients / number of treatment × 100%. Results 604 patients were aged between 40 and 96 years with average age (mean 63.44±10.12 years, including 259 males and 345 females. The mean duration of hypertension was 8.5±8.2 years and the hospitalization period was 10 to 20 days. The systolic blood pressure of the patients decreased from 151.9±15.6 mmHg to 128.5±8.0 mmHg, and the diastolic blood pressure decreased from 91.7 ± 9.8 mmHg to 79.6±4.9 mmHg after treatment. The overall compliance rate was 98.5% for all patients, and the compliance rates were 100%, 99.4%, 97.82% respectively in hypertension patients in level 1, 2 and 3. In the use of drugs, 563 patients (93.2%) selected recommended agents; 31 patients (5.1%) using traditional formulations +recommended preparations; 10 patients (1.6%) using traditional Chinese medicine preparations + recommended agents. In the recommended formulation, the proportions of the single preparation, the two preparations and the three preparations were 54.88%, 40.6% and 4.4%, respectively. 67.6% of the single preparation used was CCB, 86.4% of the two preparations used was CCB + ACEI / ARB, 68.0% of the three preparations used was ACEI + ARB + βRB and 4.0% of the three preparations used was CCB + ACEI + ARB. Conclusions Treatment of hypertension hospitalized patients of primary hospital met the standard, the overall compliance rate was over 98%. More than 93% of the patients used the recommended formulation. The use of single and two formulations met the standard,but some drugs with same mechanism were repeatedly used when using three formulations together, which may be the reason of uncontrolled blood pressure of few patients.