高校在职职工高血压患者规范化管理效果评价

发布时间：2018-08-22 08:29

【摘要】：目的:立足于高校这一职业场所,对国内高校的在职职工高血压患者进行为期两年的规范化管理,并评价其管理效果,主要内容包括高校在职职工高血压患者血压水平的变化、血压控制率的变化、饮食生活行为方式的变化、高血压患者生活质量、以及其他相关评价指标等。方法:本研究从项目课题纳入的20个分中心中选取了职业场所为高校的3个分中心,共包括国内8所高校,并从高校的职工中筛选出高血患者,按3:1的比例随机纳入管理组和常规组,并按照职业场所心血管病一级预防方案、高血压患者管理方案等对管理组高血压患者进行规范化管理,随访时间为期2年;常规组按照目前常规管理办法要求开展相关工作,但不设项目专员,只在项目开始和结束时收集2次相关资料。结果:1.血压水平及血压控制率得到良好控制。无论是SBP还是DBP,经规范化管理后管理组的血压水平有显著的下降趋势,与基线相比,SBP平均水平下降10.1mmHg(P0.05),DBP平均水平下降8.2mmHg(P0.05),差异有统计学意义;血压控制率由基线的31.5%在2年后上升至66.8%,控制率有较为明显的上升;2.生化指标异常率的变化不明显。无论是管理组自身与基线的比较,还是管理组与常规组在第24月末期的比较,血肌酐、空腹血糖、甘油三酯、总胆固醇的异常率均无明显变化。3.饮食、生活行为方式有很大的改善。饮食口味方面,管理组饮食喜好偏咸口味的人数显著降低,两年后与基线相比下降24.7%;管理组在随访一年后限制摄入高脂肪的人数占57.9%,较基线上升7.7%;在随访2年后限制摄入高脂肪的人数占81.1%,较基线上升30.9%;管理组1年后吸烟率为27.1%,较基线下降6.3%;饮酒率为24.5%,较基线下降18.3%。两年后吸烟率为25.2%,较基线下降8.2%,饮酒率为17.8%,较基线下降25.9%;管理组1年后规律运动人数为347人,占比70.2%,较基线上升19.6%,2年后规律运动人数为400人,占比81.1%,较基线上升30.5%。4.高血压患者的生活质量有了明显的提高。本研究基于量表"高血压患者生活质量问卷"来评价高校职工高血压患者生活质量。结果显示,经过两年规范化管理后,管理组与常规组相比生活质量有所改善。结论:1通过职业人群高血压规范化管理,可以显著降低高血压患者血压水平,提高高血压患者的血压控制率;2通过职业人群高血压规范化管理,可以降低吸烟率、饮酒率、提高规律运动率,改变高盐、高脂肪饮食等行为;3基于高血压生活质量问卷(MINICHAL)评价高血压患者生活质量具有良好的信度和效度,通过职业人群高血压规范化管理,对改善高校在职职工高血压患者生活质量有明显的效果;4本研究基于国内高等院校这一特殊的职业场所,充分利用校内的各项资源,对高校职工高血压患者实施规范化管理,并取得了很好的效果,说明在高校职业场所开展对高血压患者的规范化管理是可行的、有效的。
[Abstract]:Objective: to carry out a two-year standardized management of hypertension patients in colleges and universities, and evaluate its management effect. The main contents include the changes of blood pressure level of hypertension patients in colleges and universities. Changes in blood pressure control rate, dietary lifestyle, quality of life in patients with hypertension, and other related indicators. Methods: in this study, 3 occupational centers were selected from 20 sub-centers of the project, including 8 colleges and universities in China, and the patients with high blood were selected from the staff and workers of colleges and universities. According to the proportion of 3:1 into the management group and the routine group, and according to the occupational cardiovascular disease prevention program, hypertension patients management program to the management group of hypertension patients standardized management, follow-up time for 2 years; The routine team carries out the relevant work according to the current routine management method, but does not have the project specialist, only collects the related information twice at the beginning and the end of the project. The result is 1: 1. Blood pressure level and blood pressure control rate are well controlled. Whether SBP or DBP, the blood pressure level of the management group was significantly decreased after standardized management. Compared with the baseline, the average level of 10.1mmHg (P0.05) and the average level of DBP (P0.05) decreased 8.2mmHg (P0.05), the difference was statistically significant. The blood pressure control rate increased from 31.5% of the baseline to 66.8% 2 years later. The change of abnormal rate of biochemical index was not obvious. The abnormal rates of serum creatinine, fasting blood glucose, triglyceride and total cholesterol were not significantly changed in the management group and the control group at the end of 24th month, regardless of the comparison between the management group itself and the baseline, or the control group and the routine group at the end of the 24th month. Diet and lifestyle have greatly improved. In terms of dietary taste, the number of people in the management group who liked salty taste significantly decreased. The number of people in the management group who restricted their intake of high fat after one year of follow-up was 57.9 percent, up 7.7 from the baseline; the number of people who restricted the intake of high fat after 2 years of follow-up accounted for 81.1, an increase of 30.9 over the baseline; and the number of people in the management group who had restricted intake of high fat after one year was 30.9. The rate of drinking was 24.5B, which was 18.3cm lower than the baseline. Two years later, the smoking rate was 25.2cm, which was 8.2 lower than the baseline, and the drinking rate was 17.8.The number of regular exercise in the management group was 347 after one year, accounting for 70.2 percent, which was 19.6 higher than the baseline. Two years later, the number of regular exercise was 400 (81.1%), which was 30.5. 4% higher than the baseline. The quality of life of patients with hypertension has been significantly improved. The purpose of this study was to evaluate the quality of life (QOL) of hypertensive patients in colleges and universities based on the questionnaire of quality of life (QOL) of hypertension patients. The results showed that after two years of standardized management, the quality of life of the management group was improved compared with the routine group. Conclusion through the standardized management of hypertension in occupational population, the blood pressure level of hypertension patients can be significantly reduced, and the blood pressure control rate of hypertension patients can be improved. 2 through the standardized management of hypertension in occupational population, smoking rate and drinking rate can be reduced. To improve the regular exercise rate and change the behavior of high salt and high fat diet etc. (3) based on the quality of life questionnaire (MINICHAL) of hypertension, it has good reliability and validity to evaluate the quality of life of patients with hypertension. There are obvious effects on improving the quality of life of hypertension patients in colleges and universities. Based on the special professional place of colleges and universities in China, this study makes full use of all kinds of resources in colleges and universities, and implements standardized management of hypertension patients among staff and workers in colleges and universities. The results show that the standardized management of hypertension is feasible and effective.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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