【作者】 夏慧；

【导师】 孟庆跃；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 高血压是人类的常见病、多发病,也是脑卒中、冠心病等心血管疾病的重要原因之一。在我国,18岁及以上的成人高血压患病率达到18.8%,患病人数将近1.6亿。虽然高血压作为一种危险因素又作为一种疾病严重危害人类的健康,但是,高血压的控制率却很低。我国高血压控制率均低于西方发达国家,农村人群血压控制率低于城市人群。为了了解山东省农村居民高血压控制现状和影响血压控制率的因素,提高农村高血压人群的血压控制率,进行了本研究。本研究的方法:通过多阶段分层随机抽样的抽样方法。根据当地经济发展水平,抽取了4个经济欠发达县:商河县、苍山县、陵县、宁阳县;2个经济中等发达县:沂源县、莱城区;2个经济发达县:广饶县、寿光县。每个县按照随机原则各抽取2个乡镇,每个乡镇随机抽取2个村,共调查了20087人。对调查对象进行问卷调查和医学检查,分析人群的健康知识水平和健康行为,以及影响高血压控制率的影响因素。本研究的主要结果:高血压知识掌握水平较低,综合防治知识了解程度低,老年患者的高血压知识水平最低;三分之一的老年人自我健康评价差,但是老年人的健康意识也很低,一半老年人不想获得健康知识;高血压人群的生活行为方式存在很多不利于血压控制的方面,盐摄入量高、吸烟率高,老年人体力活动时间少,青年和中年人群的超重肥胖率达到70%以上。该人群的自报服药依从性较高,老年人有70%以上服药依从性好。对三组人群的高血压控制率多因素分析结果表明:影响青年高血压患者控制率的因素是家族史、是否有并发症和行为方式改变;影响中年患者血压控制率的因素有高血压病程和服用药物种类;高血压病程是影响老年高血压患者控制率的因素。结论:山东省农村高血压人群尤其是老年高血压人群的血压控制率低。应当加强对农村人群的健康教育与健康促进,提高高血压知识掌握水平、改变生活行为方式和恰当服用药物来提高高血压控制率。政策建议:1)在农村社区人群中实施以健康教育和健康促进为主导、以高血压防治为重点的干预措施。在一般人群中预防高血压的发生,在高危人群中降低血压的水平,提高高血压病人的管理率。2)针对老年人的文化层次低、理解力差以及社会、心理特点,开展健康教育时注重内容的通俗易懂、干预方式简便易行,提高他们自我保健能力和水平。同时适当加强康复干预、心理治疗和长期护理。3)加强农村基层卫生人员的队伍建设。以高血压的预防、诊断、治疗和康复为切入点,通过继续教育、培训、选派专家下农村等多种形式提高基层医生的高血压防治水平。更多还原

【Abstract】 Hypertension is not only a common disease among human beings, but also the main cause of stroke and cardiovascular diseases. Although it has been regarded as a serious disease as well as an influential risk factor of health, its control rate is low. In China, the control rate of hypertension is lower than that of western countries. It is also a matter that the control rate in rural area is considerably lower than that of urban areas. This study aims to depict the status quo of hypertension control in rural areas of Shandong Province, and to improve control policies of hypertension for the rural population.Multistage stratified random sampling was adopted to get research sample. According to development levels of economics, we select 4 low economic level Countries: Shanghe Country, Cangshan Country, Ling Country, Ningyang Country; 2 middle economic level Countries: Yiyuan Country, Laicheng Country; 2 high economic level: Shouguang Country, Guangrao Country. A total of 20087 rural residents were selected. Household survey and physical tests were carried out. Health knowledge, health behaviors, and determinants of hypertensive control rate were analyzed.Results: The attained health knowledge, with respect to hypertensive prevention and control, was relatively low in rural patients, particularly in aged patients. Self-evaluated health status was poor for one third of the aged rural residents. Additionally, a half of the aged residents did not want to attain health knowledge. Further more, the health behaviors of some hypertensive patients went against blood pressure control: high salt diet, tobacco consumption, lack of physical activities in aged patients, the prevalence of overweight and obesity in young and middle-aged patients was higher than 70%. Self-reported drug therapy adherence was good in rural hypertensive patients. More than 70% of the old patients could adhere to drug therapies. Multivariable analysis showed that family history, hypertensive complications, and adjustments of health behaviors were determinants of hypertensive control rate in young patients. Duration of hypertension and types of antihypertensive were determinants of hypertensive control rate in middle-aged patients. In aged patients, duration of hypertension was the only determinant of control rate.Conclusion: Hypertensive control rate was poor in rural residents of Shandong Province, especially in old patients. In order to advance hypertension control, health education and health promotion should be improved in rural population; hypertensive knowledge attainment should be increased; health behaviors adjustments and appropriate drug therapies should be adopted.Suggestions: 1) Interventions which focus on hypertension prevention and control should be implemented in rural communities, mainly with formats of health education and health promotion. Prevent hypertension in general population, reduce blood pressure level in high risk population, and improve patient management. 2) The health education for aged population should be more understandable and feasible, taking account of the social psychological characteristics of old people. Meanwhile, rehabilitation interventions, psychological therapies, and long-term care should be advanced. 3) Enhance the human resource of health institutions. The professional skills on hypertension of rural health workers could be improved through continuing education, training, and reallocating experts to rural areas, with starting points on prevention, diagnosis, treatments and recovering.更多还原