本文關鍵詞： 高血壓 綜合治療 門診管理 Morisky依從性量表 危險因素 瑞舒伐他汀 氯沙坦鉀　出處：《河北北方學院》2016年碩士論文　論文類型：學位論文

【摘要】：高血壓是一種心血管綜合征,是最常見的心血管疾病,然而就我國目前情況來看,高血壓患者的綜合治療管理情況不盡如人意。面對知曉率、治療率、控制率低;患病率、致殘率、致死率高;患者不規(guī)律服藥、不難受不吃藥、不愛用藥,高血壓“三高三低三不”的問題,建立一套規(guī)范化的高血壓管理模式顯得尤為重要。本研究的目的是初步探索適合門診高血壓患者的綜合治療管理方法,評價此方法的綜合干預效果;同時觀察高血壓伴高脂血癥患者服用瑞舒伐他汀對血脂指標、炎癥因子和踝臂指數(shù)的影響;觀察老年原發(fā)性高血壓合并高尿酸血癥患者服用氯沙坦鉀對血壓、血尿酸等的影響。為提高高血壓患者的治療率和達標率,綜合防治心血管危險因素提供借鑒。研究人員根據(jù)最新的《中國高血壓防治指南》、《中國高血壓基層管理指南》、《中國高血壓患者教育指南》、《中國血壓測量指南》、《家庭血壓監(jiān)測中國專家共識》等指南共識,初步建立門診高血壓患者綜合治療管理方法。并結合本地區(qū)患者的實際情況及門診專家工作經(jīng)驗總結制訂出一個優(yōu)化的治療管理方案。收集2013年11月至2014年6月期間于門診就診的1270例高血壓患者,按納入先后順序依次編號,隨機分為對照組(n=636)和管理組(n=634)。對照組接受常規(guī)門診治療,管理組在常規(guī)門診治療的基礎上發(fā)放“兩表一方”(本課題組制定的用于高血壓患者治療管理的紙質表格)進行全程管理。所有患者在入組前后分別填寫調查問卷,測量相關指標,隨訪1年。短期觀察40例高血壓伴高脂血癥患者服用瑞舒伐他汀對血脂指標、炎癥因子和踝臂指數(shù)的影響。觀察40例老年原發(fā)性高血壓合并高尿酸血癥患者服用國產(chǎn)氯沙坦鉀片對血壓、血尿酸等的影響。使用Excel表格進行數(shù)據(jù)錄入,建立數(shù)據(jù)庫。采用SPSS17.0軟件進行統(tǒng)計學分析,以P0.05為差異有統(tǒng)計學意義。本研究結果顯示,門診高血壓患者治療依從性普遍較差,患者多合并其他心腦血管危險因素,發(fā)生率較高的有:高同型半胱氨酸血癥、高脂血癥、高尿酸血癥、糖耐量異常和超重等。與同組管理前比較,1年后,管理組的家庭自測血壓率(94.5%比31.3%)、服藥依從率(79.1%比36.6%)、治療率(87.3%比50.3%)、血壓控制率(82.8%比26.1%)均明顯提高,差異有統(tǒng)計學意義(均P0.01);總膽固醇(82.6%比21.6%)、低密度脂蛋白膽固醇(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%)達標率明顯提高,差異有統(tǒng)計學意義(均P0.01);低鹽飲食、規(guī)律運動人數(shù)明顯增加,吸煙飲酒人數(shù)明顯下降,差異有統(tǒng)計學意義(均P0.01);但超重或肥胖檢出率差異無統(tǒng)計學意義(P0.05);對照組僅同型半胱氨酸達標率增加有統(tǒng)計學意義(P0.05)。兩組合理用藥率明顯提高,但管理組明顯高于對照組,差異有統(tǒng)計學意義(均P0.01)。藥物觀察結果顯示,經(jīng)過8周治療,與普伐他汀組比較,瑞舒伐他汀組總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、hs-CRP顯著降低,ABI顯著增高(P0.05);經(jīng)過8周治療,氯沙坦鉀組(試驗組)與坎地沙坦酯組(對照組)血壓下降幅度分別為(19.65±12.23)/(11.80±8.21)mmHg和(24.78±15.38)/(13.93±10.60)mmHg,治療后血壓顯著低于治療前(P0.05),組間差異無統(tǒng)計學意義(P0.05),治療后,試驗組血尿酸水平為(435.04±53.57)μmol·L-1,對照組為(483.68±63.50)μmol·L-1,試驗組顯著低于對照組和治療前(P0.05)。本研究結果表明,對門診高血壓患者進行綜合治療強化管理能明顯提高該類人群的治療依從性和血壓控制率,能有效控制患者心血管危險因素。瑞舒伐他汀能夠顯著降低高血壓伴高脂血癥患者各項血脂指標及hs-CRP水平,減輕血管炎性反應,并且明顯提高ABI,改善患者的動脈彈性功能。國產(chǎn)氯沙坦鉀片對老年原發(fā)性高血壓伴高尿酸血癥患者具有良好的降壓作用,能顯著降低患者血尿酸水平,不良反應發(fā)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紓鏈夌粺璁″鎰忎箟(鍧嘝0.01).鑽墿瑙傚療緇撴灉鏄劇ず,緇忚繃8鍛ㄦ不鐤，

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