【作者】 李杰；

【导师】 张勇；

【作者基本信息】 重庆医科大学 ， 公共卫生（专业学位）， 2018， 硕士

【摘要】 背景如今高血压患病率呈逐年剧增趋势,且知晓率和控制率低,有效控制高血压已成为全球面临的重大公共卫生问题之一。除药物治疗外,饮食对高血压病人血压的降低和控制也尤为重要,而饮食管理面临着投入的人力、时间成本高,随访困难,健康数据更新不及时等弊端。随着移动通讯设备的兴起和互联网使用的普及,“移动医疗(mHealth)”概念在“互联网~+”大环境下出现,其能提供一种便捷医疗服务及个性化健康管理,在用户和医务健康工作者之间搭建起良好互动平台,是未来医疗及健康行业的发展趋势。而移动医疗的实际规模化应用也需要各类健康管理类研究加以探索和验证。目的拟解决目前饮食管理中的难点问题,建立一种基于mHealth的慢病管理模式。通过小范围试用,以个案形式初步探讨基于移动互联网的高血压病人饮食管理方式和饮食照片评估技术的可行性,并评估其对患者饮食行为及健康指标的影响和改善作用,为后期规模化应用提供参考。方法本研究基于互联网健康管理平台和高血压推荐DASH饮食指南对高血压病人进行饮食指导和管理。病人知情同意入组后,研究人员和病人分别使用移动医疗App医生端和客户端,让病人发送饮食照片和文字描述反映饮食情况。根据制定的饮食打分表做定量评估,做到DASH膳食原则中的一条得1分,未做到不得分,早、中、晚三餐饮食满分为6分,一天饮食满分为10分。并结合病人身体情况和饮食得分做定性评估,判断其吃得是否“正确”。鼓励其努力达到推荐饮食标准,如未达到,继续评估饮食和反馈,直至病人饮食行为发生改变并维持,实现自我饮食管理。日常生活中提供针对性饮食建议与咨询答疑,保持与病人的沟通互动。收集病人的饮食图片和文字资料,并结合健康管理后台的实时监测数据,观察病人饮食行为和体重、血压等生理指标及情绪变化。结果本研究构建了基于移动医疗的高血压饮食管理模式,包括患者入组建档,饮食照片评估与反馈,记录饮食行为和健康指标,阶段性评估膳食和健康指标,饮食管理总结。结合小规模的试用和3个典型案例分析发现,基于移动设备的mHealth在高血压病人的饮食指导管理方式上可以让用户随时随地接受饮食指导,开展健康教育,采集健康数据,反馈健康信息,与研究人员沟通交流等,缩减了时间和人力成本。通过图片发送方式和图片解读更容易收集到饮食数据,通过蓝牙设备更容易采集用户的健康信息,可视化的数据展示也更容易为用户与健康管理者所接受。但另外一方面,参与饮食管理的病人失访率很高,其中40~49岁人群最高,更大年龄的病人发送饮食照片依从性更好。依从性较好的病人,参与饮食管理后,并接受DASH饮食的指导,各餐食物种类逐渐增加,每天的水果摄入量增加,烹调油和盐摄入量有所减少。早餐饮食得分平均增加了1.3分;午餐饮食得分平均增加了2.3分;晚餐饮食得分平均增加了1.7分;一天饮食得分平均增加了1.3分。饮食行为能逐渐朝着高血压推荐饮食方向改变,且收缩压平均降低了13.3mmHg;舒张压平均降低了4.7 mmHg,另外体重等生理指标得到一定改善,自我主观评价也有所提升。结论基于移动医疗的高血压病人饮食管理方式可行,有助于通过信息采集,可视化信息反馈,健康教育,个性化的健康指导改变病人饮食行为,提升身体状况和健康水平,降低和节约管理成本。但下一步仍需在大量的基础工作上对饮食照片识别和评估技术做进一步优化和实现半自动化,对用户的反馈信息更实时化、个性化和精确化,以提高管理效率和用户的依从性,才能进一步实现高血压等慢性病患者饮食和健康管理的规模化。更多还原

【Abstract】 Background Nowadays the prevalence of hypertension is increasing rapidly year by year,and the rate of awareness and control is low.Effective control of hypertension has become one of the major public health issues facing the world.In addition to drug treatment,diet is also particularly important in reduction and control of blood pressure in hypertensive patients.however,diet management is faced with the manpower,time,high cost,follow-up difficulties,health data update is not timely and other shortcomings.With the rise of mobile communication devices and the popularity of Internet use,the concept of “mHealth” emerged under the “Internet+” environment,which can provide a convenient medical service and personalized health management,in user and medical health.The establishment of a good interactive platform is an inevitable trend in the future healthcare industry.The actual scale application of mobile medical care also needs various types of health management research to explore and verify.Objective To solve the current difficulties in diet management,establish a mHealth-based chronic disease management model.Through small-scale trials,the feasibility of dietary management and dietary photo assessment techniques for hypertensive patients based on mobile internet was initially discussed in a case-by-case format.The impact and improvement of dietary behaviors and health indicators on patients were evaluated and used for later scale applications.for reference.Methods This study conducted dietary guidance and management of hypertensive patients based on the Internet health management platform and hypertension recommended DASH dietary guidelines.After the patient’s informed consent was entered into the group,the researchers and the patient used the “mHealth” App doctor and client,respectively,to allow the patient to send diet photos and text descriptions reflecting the diet.According to the dietary score table formulated to make a quantitative assessment,one of the DASH dietary principles scored 1 point,and did not achieve non-score.The three-meal dietary score of the breakfast,lunch and dinner was 6 points,and the one-day diet score was 10 points.In combination with the patient’s physical condition and dietary scores,a qualitative assessment was made to determine whether it was "correct." Encourage them to strive to meet the recommended dietary standards,and if not,continue to assess diet and feedback until the patient’s dietary behavior changes and maintains,achieving self-catering management.Daily dietary advice and counseling are provided in daily life to maintain communication and interaction with patients.Gather the patient’s dietary pictures and text data,and combine the real-time monitoring data of the health management background to observe the patient’s dietary behavior and body weight,blood pressure and other physiological indicators and emotional changes.Results This study constructed a hypertension-based diet management model based on mobile health care,including patient inclusion,dietary photo assessment and feedback,dietary behavior and health indicators,dietary and health assessments,and dietary management reviews.Combined with a small-scale trial and three typical case studies,it is found that mHealth based on mobile devices can provide users with food guidance,health education,health data collection,and feedback on health information at any time and anywhere.Researchers communicate and reduce time and labor costs.It is easier to collect dietary data through image delivery methods and image interpretation.It is easier to collect user health information through Bluetooth devices,and visual data display is also easier for users and health managers to accept.On the other hand,the rate of loss of patients participating in diet management was high,among them the 40-to 49-year-old population was the highest,and patients of older age had better adherence to diet photos.Patients with better compliance,after participating in dietary management,and receiving guidance from the DASH diet,the types of foods for each meal gradually increased,daily fruit intake increased,and cooking oil and salt intake decreased.The breakfast diet score increased by an average of 1.3 points;the lunch diet score increased by an average of 2.3 points;the dinner diet score increased by an average of 1.7 points;and the average daily diet score increased by 1.3 points.Dietary behavior can gradually change towards the direction of high blood pressure recommended diet,and systolic blood pressure decreased by an average of 13.3mmHg;diastolic blood pressure decreased by an average of 4.7mmHg,in addition to certain improvements in body weight and other physiological indicators,subjective evaluation of self has improved.Conclusion Based on mobile health care,the dietary management of hypertensive patients is feasible,which helps to change the dietary behaviors of patients through information collection,visual information feedback,health education,personalized health guidance,improve physical condition and health level,and reduce and save management costs.However,the next step is still to further optimize and implement semi-automated food photo recognition and assessment techniques on a large number of basic tasks,and to provide more real-time,personalized,and accurate feedback information to users to improve management efficiency and user compliance.In order to further realize the scale of diet and health management of patients with chronic diseases such as hypertension.更多还原