高血压患者门诊综合治疗管理方法与效果研究

发布时间：2018-03-01 14:35

  本文关键词： 高血压 综合治疗 门诊管理 Morisky依从性量表 危险因素 瑞舒伐他汀 氯沙坦钾　出处：《河北北方学院》2016年硕士论文　论文类型：学位论文

【摘要】：高血压是一种心血管综合征,是最常见的心血管疾病,然而就我国目前情况来看,高血压患者的综合治疗管理情况不尽如人意。面对知晓率、治疗率、控制率低;患病率、致残率、致死率高;患者不规律服药、不难受不吃药、不爱用药,高血压“三高三低三不”的问题,建立一套规范化的高血压管理模式显得尤为重要。本研究的目的是初步探索适合门诊高血压患者的综合治疗管理方法,评价此方法的综合干预效果;同时观察高血压伴高脂血症患者服用瑞舒伐他汀对血脂指标、炎症因子和踝臂指数的影响;观察老年原发性高血压合并高尿酸血症患者服用氯沙坦钾对血压、血尿酸等的影响。为提高高血压患者的治疗率和达标率,综合防治心血管危险因素提供借鉴。研究人员根据最新的《中国高血压防治指南》、《中国高血压基层管理指南》、《中国高血压患者教育指南》、《中国血压测量指南》、《家庭血压监测中国专家共识》等指南共识,初步建立门诊高血压患者综合治疗管理方法。并结合本地区患者的实际情况及门诊专家工作经验总结制订出一个优化的治疗管理方案。收集2013年11月至2014年6月期间于门诊就诊的1270例高血压患者,按纳入先后顺序依次编号,随机分为对照组(n=636)和管理组(n=634)。对照组接受常规门诊治疗,管理组在常规门诊治疗的基础上发放“两表一方”(本课题组制定的用于高血压患者治疗管理的纸质表格)进行全程管理。所有患者在入组前后分别填写调查问卷,测量相关指标,随访1年。短期观察40例高血压伴高脂血症患者服用瑞舒伐他汀对血脂指标、炎症因子和踝臂指数的影响。观察40例老年原发性高血压合并高尿酸血症患者服用国产氯沙坦钾片对血压、血尿酸等的影响。使用Excel表格进行数据录入,建立数据库。采用SPSS17.0软件进行统计学分析,以P0.05为差异有统计学意义。本研究结果显示,门诊高血压患者治疗依从性普遍较差,患者多合并其他心脑血管危险因素,发生率较高的有:高同型半胱氨酸血症、高脂血症、高尿酸血症、糖耐量异常和超重等。与同组管理前比较,1年后,管理组的家庭自测血压率(94.5%比31.3%)、服药依从率(79.1%比36.6%)、治疗率(87.3%比50.3%)、血压控制率(82.8%比26.1%)均明显提高,差异有统计学意义(均P0.01);总胆固醇(82.6%比21.6%)、低密度脂蛋白胆固醇(85.6%比27.1%)、三酰甘油(84.3%比53.7%)、空腹血糖(94.1%比83.3%)及同型半胱氨酸(88.3%比18.7%)达标率明显提高,差异有统计学意义(均P0.01);低盐饮食、规律运动人数明显增加,吸烟饮酒人数明显下降,差异有统计学意义(均P0.01);但超重或肥胖检出率差异无统计学意义(P0.05);对照组仅同型半胱氨酸达标率增加有统计学意义(P0.05)。两组合理用药率明显提高,但管理组明显高于对照组,差异有统计学意义(均P0.01)。药物观察结果显示,经过8周治疗,与普伐他汀组比较,瑞舒伐他汀组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP显著降低,ABI显著增高(P0.05);经过8周治疗,氯沙坦钾组(试验组)与坎地沙坦酯组(对照组)血压下降幅度分别为(19.65±12.23)/(11.80±8.21)mmHg和(24.78±15.38)/(13.93±10.60)mmHg,治疗后血压显著低于治疗前(P0.05),组间差异无统计学意义(P0.05),治疗后,试验组血尿酸水平为(435.04±53.57)μmol·L-1,对照组为(483.68±63.50)μmol·L-1,试验组显著低于对照组和治疗前(P0.05)。本研究结果表明,对门诊高血压患者进行综合治疗强化管理能明显提高该类人群的治疗依从性和血压控制率,能有效控制患者心血管危险因素。瑞舒伐他汀能够显著降低高血压伴高脂血症患者各项血脂指标及hs-CRP水平,减轻血管炎性反应,并且明显提高ABI,改善患者的动脉弹性功能。国产氯沙坦钾片对老年原发性高血压伴高尿酸血症患者具有良好的降压作用,能显著降低患者血尿酸水平,不良反应发生率低。
[Abstract]:Hypertension is a kind of cardiovascular syndrome is the most common cardiovascular disease, but the current situation in our country, the comprehensive treatment of patients with hypertension management is not satisfactory. Facing the awareness rate, treatment rate, control rate is low; the prevalence rate, disability rate, death rate is high; the patient medication is not the law, do not take medicine not bad don't love, hypertension medication, "three high and three low three", establish a set of standardized management of hypertension is particularly important. The purpose of this study is to explore the management methods for the comprehensive treatment of outpatients with hypertension, comprehensive intervention effect evaluation of this method; at the same time to observe the hypertension and hyperlipidemia patients Rui rosuvastatin on serum lipids, inflammatory factors and ankle brachial index; observation of elderly patients with primary hyperuricemia and hypertension treated with losartan on blood pressure, hematuria acid. As a reference High in patients with hypertension treatment and control rates, provide reference for comprehensive prevention and treatment of cardiovascular risk factors. The researchers according to the new guidelines for the prevention and treatment of hypertension Chinese < >, < > Chinese basic guidelines for the management of hypertension, "China hypertension education guidelines >, < < > China blood pressure measurement guidelines, home blood pressure monitoring Chinese expert consensus guidelines > consensus, preliminary establishment of comprehensive treatment in patients with hypertension management. Combined with the actual situation and experience of outpatient expert region patients proposed an optimization scheme of treatment and management. During the period from November 2013 to June 2014 in the outpatient treatment of 1270 cases of patients with hypertension, according to inclusion successively number, were randomly divided into control group (n=636) and management group (n=634). The control group received routine outpatient treatment, management group" two party payment table on the basis of routine outpatient treatment "(the research group for The paper form for treatment in patients with hypertension management for the whole management). All patients enrolled in the group before and after completing the questionnaire, relevant indicators of measurement, follow-up of 1 years. The short-term observation of 40 cases of hypertension and hyperlipidemia in patients with Fu Yongrui rosuvastatin on serum lipids, inflammatory factors and ankle brachial index were observed in 40 cases. In elderly patients with essential hypertension complicated with hyperuricemia treated domestic Losartan Potassium Tablets on blood pressure, blood uric acid and other effects. Use Excel for data entry, to establish the database. SPSS17.0 software was used for statistical analysis by P0.05, the difference was statistically significant. The results of this study show that outpatient treatment compliance in patients with hypertension is generally poor, many patients were complicated with other cardiovascular and vascular risk factors, high incidence rate: high homocysteine, hyperlipidemia, hyperuricemia, and the amount of abnormal glucose tolerance often overweight . compared with the same group before, after 1 years, the rate of family self testing blood pressure management group (94.5% vs 31.3%), the compliance rate (79.1% vs 36.6%), treatment rate (87.3% vs 50.3%), blood pressure control rate (82.8% vs 26.1%) were significantly improved, the difference was statistically significant (P0.01); total cholesterol (82.6% vs 21.6%), low density lipoprotein cholesterol (85.6% vs 27.1%), three glycerol (84.3% vs 53.7%), fasting glucose (94.1% vs 83.3%) and homocysteine (88.3% vs 18.7%) compliance was significantly increased, the difference was statistically significant (P0.01); low salt diet, regular exercise a marked increase in the number of smoking and drinking number decreased significantly, the difference was statistically significant (P0.01); but the overweight or obesity rates were not statistically significant (P0.05); the control group only homocysteine compliance rate increased with statistical significance (P0.05). The two group medication rate increased significantly, but the management group was significantly higher than the control group ,宸�寮傛湁缁熻�″�︽剰涔�(鍧嘝0.01).鑽�鐗╄�傚療缁撴灉鏄剧ず,缁忚繃8鍛ㄦ不鐤，

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