家庭远程血压监测在高血压患者中应用的研究

发布时间：2018-07-12 11:39

本文选题：家庭血压 + 远程血压监测　；参考：《南方医科大学》2017年硕士论文

【摘要】：本研究通过开展随机对照临床试验,对比家庭远程血压监测方法和传统血压管理方法在高血压患者中应用的临床效果。另外,由于本临床研究的的研究对象主要集中在我院及下辖社区,为非多中心研究,同时因样本量小,以及随访时间短等原因,我们通过收集了近年来已发表的相关文献进行系统评价及Meta分析,以弥补上述临床试验的不足。本研究共分为两部分进行论述:第一部分基于物联网的家庭远程血压监测在高血压患者中初步应用的临床研究目的:探讨基于物联网的家庭远程血压监测方法较传统高血压管理方法对高血压病患者血压控制、用药依从性、生活质量、药物治疗强度、延续性等方面的影响。方法:对入选的142名高血压患者,随机分为对照组和干预组。对照组患者采用传统的门诊血压管理方法,干预组采用物联网的家庭远程血压管理。通过12个月随访,分析比较两组中患者的血压控制情况、用药依从性、生活质量等;在干预“洗脱期”,评价远程血压干预的延续效应。结果:12个月的远程干预结束时,干预组患者血压明显低于对照组(P0.05),且血压达标率明显高于对照组(P0.05);干预组患者用药依从性明显优于对照组(P0.05);生活质量评分和治疗强度两组间无明显差异(P0.05);6个月的洗脱期后,干预组仍表现出较对照组更好的血压控制及用药依从性(P0.05)。结论:与传统的管理方式相比,基于物联网的高血压的远程管理方法能够更大程度的降低血压,提高血压的达标率,增进用药依从性。第二部分家庭远程血压监测的临床效果:一项基于随机对照研究的系统评价及Meta分析目的:进一步探讨关于家庭远程血压监测的临床效果及其关键组成部分。方法:通过检索PubMed、EMBASE和Cochrane等多个数据库,查找相关期刊论文、会议论文及其他灰色文献。结果:经过严格的筛选后共纳入46篇文献,包含13875例患者。血压变化:与对照组相比,家庭血压监测组患者收缩压和舒张压的下降幅度分别为3.99mmHg和1.99mmHg(P均0.05)。对于动态血压变化情况,无论收缩压(-4.41 mmHg)和舒张压(-2.33mmHg)家庭远程血压监测组均明显高于对照组(P0.05)。血压达标率:家庭远程血压监测组患者血压达标率明显高于对照组。次要指标:各指标均未发现明显的组间差异。亚组分析:与对照组相比,在随访时间为6或12月、使用基于电脑的数据传输方式,或伴有咨询的额外支持方法的亚组中,远程血压监测可以更好的控制血压。结论:家庭远程血压监测方法较传统方法能更好的控制血压;使用合适的干预工具或者提供积极主动的额外支持,将会有更好的血压控制效果。
[Abstract]:In this study, a randomized controlled clinical trial was conducted to compare the clinical effects of home remote blood pressure monitoring and traditional blood pressure management in hypertensive patients. In addition, because the subjects of this clinical study are mainly concentrated in our hospital and the community under their jurisdiction, they are non-multicenter studies. At the same time, the sample size is small, and the follow-up time is short, and so on. In order to make up for the deficiency of the above clinical trials, we collected the literature published in recent years for systematic evaluation and meta-analysis. This study is divided into two parts: the first part is the clinical study of the primary application of remote home blood pressure monitoring based on the Internet of things in patients with hypertension objective: to explore the method of remote blood pressure monitoring based on the Internet of things. Traditional hypertension management methods to control the blood pressure of patients with hypertension, Drug compliance, quality of life, drug treatment intensity, continuity and so on. Methods: 142 patients with hypertension were randomly divided into control group and intervention group. The control group adopted the traditional outpatient blood pressure management method, the intervention group adopted the remote blood pressure management based on Internet of things. After 12 months follow-up, the blood pressure control, drug compliance and quality of life of patients in the two groups were analyzed and compared, and the continuation effect of remote blood pressure intervention was evaluated during the "elution period". Results: at the end of 12 months of remote intervention, The blood pressure of the intervention group was significantly lower than that of the control group (P0.05), and the rate of blood pressure reaching the standard was significantly higher than that of the control group (P0.05); the drug compliance of the intervention group was significantly better than that of the control group (P0.05); there was no significant difference between the two groups in quality of life score and treatment intensity (P0.05); after 6 months of elution, there was no significant difference between the two groups. The intervention group still showed better blood pressure control and drug compliance than the control group (P0.05). Conclusion: compared with traditional management, remote management of hypertension based on Internet of things can lower blood pressure, improve blood pressure compliance and improve drug compliance. The second part: clinical effect of home remote blood pressure monitoring: a systematic evaluation and meta-analysis based on randomized controlled study objective: to further explore the clinical effect and key components of household remote blood pressure monitoring. Methods: through searching several databases of PubMedus EMBASE and Cochrane, we searched for related journal papers, conference papers and other grey papers. Results: a total of 46 articles including 13875 patients were included after strict screening. Changes of blood pressure: the decrease of systolic and diastolic blood pressure were 3.99mmHg and 1.99mmHg respectively in the family blood pressure monitoring group compared with the control group (P 0.05). Both systolic blood pressure (-4.41 mmHg) and diastolic blood pressure (-2.33 mmHg) were significantly higher in the ambulatory blood pressure monitoring group than in the control group (P0.05). The blood pressure reached the standard rate in the home remote blood pressure monitoring group was significantly higher than that in the control group. Secondary indicators: no significant differences between groups were found in each index. Subgroup analysis: remote blood pressure monitoring was more effective in controlling blood pressure in groups that were followed up for 6 or 12 months using computer-based data transmission or additional support with counseling. Conclusion: the home remote blood pressure monitoring method can control blood pressure better than the traditional method, and it will have better blood pressure control effect by using appropriate intervention tools or providing active and additional support.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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