【作者】 姜峰；

【导师】 张虹；

【作者基本信息】 山西医科大学 ， 内科学（专业学位）， 2016， 硕士

【摘要】 目的:本研究拟探讨“医患双达标”医疗模式对高血压患者综合干预的应用效果,为提高高血压患者血压和其它相关心血管危险因素的达标率提供实用、有效的临床管理模式。方法:2014年9月—2015年9月招募在山西省人民医院心内二科门诊就诊的2,3级高血压患者300例。依据患者就诊日期的单双日依次入组干预治疗组和常规治疗组,完成全部研究的患者共283例,其中干预治疗组146例,常规治疗组137例。两组患者均由临床医师制定适合患者个体化治疗方案,并4周、12周、24周到门诊随访;其中临床医师使用“健康达标手册”对干预治疗组患者进行教育,告知血压及相关危险因素的管理的达标值,同时高血压管理专员对患者进行的电话随访和教育。临床医生仅给予常规治疗组患者口头的高血压健康教育。结果:(1)两组患者在性别、年龄、BMI(体重指数)、高血压伴随临床疾患、平均血压值、TC(总胆固醇)、LDL-c(低密度脂蛋白胆固醇)、UA(尿酸)、Hcy(同型半胱氨酸)、m Alb(尿微量白蛋白)均无明显差异(P>0.05)。(2)干预治疗组患者经过24周的管理平均收缩压下降19.66mm Hg、平均舒张压下降12.20mm Hg,2、3级度高血压患者显著减少;第24周干预治疗组患者血压与自身基线及管理后24周的常规治疗组平均血压相比较,差异有统计学意义(P<0.05);干预治疗组患者血压控制率在管理24周后上升至74.66%,显著高于常规治疗组24周的52.55%,差异具有统计学意义(P<0.01)。(3)干预治疗组在管理24周后总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿酸、同型半胱氨酸均值与常规治疗组及基线比较,差异具有统计学意义(P<0.05);但管理24周后干预治疗组患者在甘油三酯、空腹血糖和尿微量白蛋白均值与自身基线及常规治疗组相比未见明显差异(P>0.05)。(4)干预治疗组较常规治疗组在管理24周后戒烟(16.00%和4.65%)、限酒(10.52%和3.84%)与吸烟量减少(68.00%和44.19%)、饮酒量减少(64.90%和46.15%)的患者比例上升明显,差异均有统计学意义(P<0.05);管理第24周干预治疗组较常规治疗组的运动量>3次/周且每次>30min的患者明显增加(50.68%和36.49%)、每日进食食盐量有所减少的患者明显增加(70.54%和47.45%),差异均具有统计学意义(P<0.05)。(5)在干预治疗组和常规治疗组中随机各抽取45名患者进行调查发现,干预治疗组患者在本次研究的高血压知识的掌握程度和满意度方面均高于常规治疗组患者。结论:“医患双达标”模式可以进一步降低中重度高血压患者的血压水平,提高血压控制率,同时降低其它心血管危险因素(包括总胆固醇、低密度脂蛋白胆固醇、尿酸、同型半胱氨酸),改善高血压患者不良的生活方式和提高其治疗的依从性。更多还原

【Abstract】 Objective:The study was to investigate application effects of “Target for both doctors and patients’ medical model and to provide a useful and effective management model which aimed to improve control rate of blood pressure and the relevant risks of hypertension patients in clinical work.Methods:Totally, 300 patients with moderate or severe hypertension had been treated in out-patient department in our hospital from September 2014 to September 2015. 283 patients had been completed and were assigned to two management groups by the admission date(odd and even number):intervention therapy group(n=146) and conventional treatment group(n=137). In two groups, Doctor formulated individual plans for patients follow-up visit or adjusted drug therapy in time; patients followed in outpatient department after 4 weeks、12 weeks、24 weeks. In intervention therapy group, Doctors used the health target manual to educate patients including target value of blood pressure and relevant risks; hypertension managers followed and educated by telephone to patients. In conventional treatment group, doctors only educated patients by oral communication.Results:(1) Intervention therapy group and conventional treatment group patients were no significant difference in age、gender、BMI、concomitant diseases、average blood pressure、TC、LDL-c、UA、Hcy、m Alb(P>0.05).(2) Intervention therapy group patients’ average systolic pressure and diastolic pressure were declined 19.66 mm Hg、12.20 mm Hg and 2、3 level of hypertension patients reduced obviously at 24 weeks. At 24 weeks, intervention therapy group patients’ average blood pressure in compared with itself baseline and conventional treatment group patients at 24 weeks were significantly(P<0.05). Control rate of blood pressure in intervention therapy group which was higher than conventional treatment group significantly at 24weeks(74.66% vs 52.55%,P<0.01).(3) At 24 weeks, intervention therapy group patients’ levels of average TC、LDL-c、UA 、 Hcy were lower and average HDL-c higher significantly than itself baseline and conventional treatment group(p<0.05). Meanwhile, at 24 weeks, intervention therapy group patients’ levels of average TG、FBG and m Alb wasn’t significantly lower than itself baseline and conventional treatment group(P>0.05).(4) Compared with conventional treatment group, the proportion of hypertension patients in intervention therapy group with smoking cessation(16.00% vs 4.65%)、drinking cessation(10.53%vs 3.84%)and smoking limitation(68.00% vs 44.19%) 、 drinking limitation(64.90% vs 46.15%) higher than significantly(P<0.05) and with physical exercise>3 times/week as well asevery time>30min significantly increased(50.68% vs36.49%)、salt intake reduction(70.54% vs 47.45%) significantly increased(p<0.05).(5) We investigated 45 patients respectively in intervention therapy group and conventional treatment group, and detected which the hypertension-related knowledge in intervention therapy group group learned more than that of patients in conventional treatment group and satisfication of patients in intervention therapy group were higher.Conclusions:“Target for both doctors and patients” medical model can not only lower the blood pressure level of moderate or severe hypertension patients, improve blood pressure control rate and reduce the level of other cardiovascular risks(including TC、LDL-c、UA 、Hcy),but also change patients’ unhealthy life and improve their compliance.更多还原