摘要
目的:通过对老年高血压病患者采用医院与社区综合的干预模式,探讨医院与社区联合干预模式对老年高血压病患者尿白蛋白肌酐比值(UACR)及药物依从性的影响。方法:以某社区老年高血压病患者240例(UACR阳性80例,阴性160例)为研究对象,随机分为对照组与观察组各120例,每组包括UACR阳性40例及阴性80例;随访周期24个月。2组患者均以高血压病二级预防治疗为基础,均由某院专科医生4周随访1次并根据其血压、UACR调整治疗方案;观察组同时由社区医师每周随访1次,进行用药督导、健康宣教、心理及生活方式干预。比较2组血压达标率及UACR变化趋势、药物治疗依从性、自我效能评分。结果:2组患者血压达标率呈上升趋势。随访6个月时,观察组的血压达标率(31.67%)开始明显高于对照组的(24.17%),随访12、24个月时观察组的血压达标率分别为60.83%、92.17%,高于对照组的35.00%及72.19%,差异具有统计学意义(P<0.05);2组UACR阳性患者UACR呈下降趋势,随访6、12及24个月时,观察组的UACR为41.60、35.60及21.60 mg·g^(-1),低于对照组的45.20、42.20及30.10 mg·g^(-1),差异具有显著性(P<0.05);随访12及24个月时,观察组的UACR转阳率为10.0%及15.0%,而对照组分别为25.00%及32.50%,转阳率显著高于的观察组(P<0.05);随访6、12及24个月时,观察组依从性好的比例为95.0%、90.8%及84.02%,高于对照组的87.5%、75.8%及72.5%,差异具有显著性(P<0.05);随访6、12及24个月时,观察组的促进因子、障碍因子及自我效能总分均显著高于对照组,差异均具有统计学意义(P<0.05)。结论:医院与社区综合干预模式可显著改善老年高血压病患者的治疗依从性、降低患者的UACR,提高其高血压的达标率,延缓高血压肾脏损害,是一种值得临床借鉴推广的老年高血压病防治模式。
OBJECTIVE To adopt the comprehensive intervention model of hospital and community in elderly patients with hypertension,explore the effect of the combined intervention model of hospital and community on urinary albumin creatinine ratio（UACR）and drug compliance in elderly patients with hypertension.METHODS Totally 240 cases of elderly patients with hypertension in a community（UACR positive 80 cases,negative 160 cases）were studied,randomly divided into the control group and the observation group,120 cases each,including 40 cases of UACR positive and 80 negative cases.The follow-up period was 24 months.The treatment regimens of two groups of patients were based on the secondary prevention of hypertensive diseases.All the patients were followed up for 1 times in4 weeks according to their blood pressure and UACR adjustment treatment program.Patients in observation group at the same time were followed up 1 time a week by the community physicians.The patients were provided with medication supervision,health education,psychological and lifestyle intervention.Blood pressure compliance rate and UACR trends,drug treatment compliance,self-efficacy score were compared between two groups.RESULTS The standard rates of blood pressure of the two groups showed a rising trend.At the 6 months follow-up,the blood pressure compliance rate（31.67%）of the observation group was significantly higher than that in the control group（24.17%）,the blood pressure compliance rates of the observation group was 60.83%,92.17%at 12 and 24 months follow-up respectively,higher than the control group of 35.00% and 72.19%（P0.05）.UACR positive patients in the two groups showed a downward trend in UACR,at 6,12 and 24 months of follow-up,the UACR of the observation group was 41.60,35.60 and 21.60 mg·g^（-1）,respectively,lower than those of the control group at 45.20,42.20 and 30.10 mg·g^（-1）（P0.05）.At the 12 and 24 months follow-up,the positive rates of UACR in the observation group were 10% and 15%,25% and32.50%in the control group（P0.05）.At 6,12 and 24 months of follow-up,the good proportions of observation group was95%,90.8% and 84.02%,higher than those of the control group at 87.5%,75.8% and 72.5%（P0.05）.At the 6,12 and 24 months of follow-up,the level of promoting factor,obstacle factor and total score of self efficacy of the observation group were significantly higher than those of the control group（P0.05）.CONCLUSION The hospital and community comprehensive intervention can improve the elderly patients with hypertension in treatment compliance,decrease the level of UACR,improve the standard rate of hypertension,and delay hypertensive renal damage.It is a worthy model of clinical reference in prevention and treatment of senile hypertension.
出处
《中国医院药学杂志》
CAS
北大核心
2018年第3期322-326,共5页
Chinese Journal of Hospital Pharmacy
关键词
综合干预
老年高血压病
UACR
依从性
comprehensive interventiom elderly patients with hypertensiom UACR
compliance
