东莞市社区高血压规范化诊疗现状与对策

Current situation and strategy for standardized diagnosis and treatment of hypertension in Dongguan community

目的探讨社区原发性高血压(高血压)规范化诊疗的现状和对策。方法回顾性抽取2017年6月至2017年8月东莞市33家社区卫生服务机构全科医生高血压患者病历32 596份,评价高血压患者的血压测量和记录、规范诊断、危险因素药物干预及并发症诊断、降压药物使用及综合干预等情况,并评价社区卫生服务中心的硬件配置和医务人员的职称、专业等情况。结果高血压患者的血压尾数为"0"约41.4%、多次复诊出现相同血压值约10.1%;高血压诊断的分级、分层约为2.9%、1.4%;脑卒中、高血压性心脏病、高血压肾病等并发症诊断率分别为2.1%、1.0%、0.8%,高脂血症、高尿酸血症、高同型半胱氨酸血症规范治疗率分别为9.24%、2.66%、0.03%。钙拮抗剂(CCB)、血管紧张素Ⅱ受体拮抗剂(ARB)、血管紧张素转换酶抑制剂(ACEI)、β受体阻断药使用率分别为67.3%、67.2%、4.8%、12.1%。社区医务人员高级、中级、初级职称分别为4.0%、29.5%、66.5%。硬件配置方面,能利用超声心动图或血管彩色超声进行高血压靶器官筛查的仅为1.9%。结论社区在高血压的测量与记录、规范诊断、危险因素药物干预、降压药物应用及并发症的筛查等方面还存在不足。同时,高级医疗人才和必需检查设备缺乏。

Objectives To explore the current situation and strategy for standardized diagnosis and treatment of hyperten?sion in community health centers of Dongguan.Methods We retrospectively collected 32 596 medical records of hypertensive patients from June to August 2017 in 33 community health centers in Dongguan.Measurement and record of blood pressure,diagnosis of hypertension,cardiovascular risk factors and complication,use of antihypertensive drugs and situation of comprehensive intervention were analyzed.Meanwhile,medical facilities and vocational level of medical staffs were also assessed.Results Proportion of occurrence of blood pressure recorded with“0”as the last digit was 41.1%,and proportion of the same blood pressure for multiple subsequent visit was 10.1%.Proportions of occurrence of diagnosis with clinical classification and risk stratification were 2.9%and 1.4%.Proportions of stroke,hypertensive heart disease and hypertensive nephropathy were 2.1%,1.0%and 0.8%.Regarding cardiovascular risk factors,prevalences of hyper-lipemia,hyper-uricemia and hyper-homocysteinemia were 9.24%,2.66%,0.03%,respectively.Usage rate of calcium channel blockers(CCB),angiotensinⅡreceptor blocker(ARBs),angiotensin converting enzyme inhibitor(ACEIs),andβreceptor-blockers were 67.3%,67.2%,4.8%and 12.1%,respectively.Proportions of senior,intermediate and junior medical staffs were 4.0%,29.5%and 66.5%,respectively.Proportion of screening hypertensive target-organ by echocardiography and intravascular ultrasound in community health centers was 1.9%.Conclusions There are some shortcomings on measurement and recording,standardized diagnosis,drug intervention for risk factors,antihypertensive drug usage and screening of complications;The number of senior medical staff and essential equipment are also insufficient in Dongguan community health centers.