2018 年第 12 期 第 13 卷

我国不同地区社区高血压病患者疾病管理现状及效果分析

Current situation of disease management in community patients with hypertension in different regions of China

作者：邓利群左惠娟王锦纹陈晓荣苏江莲马吉祥

英文作者：

单位：100029首都医科大学附属北京安贞医院全科医疗科（邓利群）；100029首都医科大学附属北京安贞医院北京市心肺血管疾病研究所人群防治研究室（左惠娟、王锦纹、苏江莲）；100050北京，中国疾病预防与控制中心慢性非传染性疾病预防控制中心（陈晓荣、马吉祥）

英文单位：

关键词：高血压；基本公共卫生服务；血压控制；健康教育

英文关键词：

• 摘要：

• 【摘要】目的    了解我国不同地区社区高血压病患者疾病管理现状及效果。方法    2014年10月至2015年3月，从山东省青岛市、乳山市、沂源县和江苏省无锡市、涟水县、射阳县以及北京市朝阳区共18个社区卫生服务中心的健康档案中随机抽取高血压病患者。通过问卷调查，收集患者一般信息、病史信息、社区基本公共卫生服务信息等资料进行统计分析。结果    我国3省（直辖市）共完成问卷2 272份，其中山东省753份，江苏省758份，北京市761份。山东省高血压患者健康教育活动参与率最高，为81.4%（613/753）；北京市高血压病患者阅读健康教育材料比例、门诊随访≥4次/年比例以及家庭自测血压的比例最高，分别为71.6%（545/761）、80.5%（613/761）和77.1%（587/761）；江苏省高血压病患者药物治疗率以及联合用药比例高于山东省和北京市［78.5%（595/758）比60.7%（457/753）、71.7%（546/761），36.8%（279/758）比18.3%（138/753）、26.4%（201/761）］，但接受减盐劝告、控制体质量建议和规律体育锻炼建议的比例均低于其他2个省市，差异均有统计学意义（均P<0.05）。北京市高血压病患者血压控制率为51.1%，高于江苏省（47.9%）和山东省（31.7%），差异有统计学意义（χ2=66.225，P＜0.001）。门诊随访≥7次/年、家庭自测血压1～3次/月、阅读健康教育相关书籍或材料、不饮酒、体育锻炼次数≥3次/周与血压控制率显著正相关（均P<0.05）。结论    高血压病患者健康教育、家庭自测血压以及门诊随访达到基本公共卫生服务标准的比例较低，且不同城市之间差别显著。不同省市社区高血压病患者血压控制率有较大差别。门诊随访≥7次/年、家庭自测血压1～3次/月、阅读健康相关书籍、规律体育锻炼、不饮酒等健康行为有利于提高血压控制率。

• 【Abstract】Objective    To investigate the current status of hypertension management in community patients in different provinces and cities of China. Methods    Between October 2014 and March 2015, hypertension patients were randomly selected from the healthy records of 18 community healthcare centers in Qingdao city, Rushan city, Yiyuan county of Shandong Province, Wuxi city, Lianshui county, Sheyang county of Jiangsu Province and Chaoyang District of Beijing. General information, medical history and public healthcare data were collected through questionnaire survey. Results    A total of 2 272 questionnaires were completed, including 753 in Shandong Province, 758 in Jiangsu Province and 761 in Beijing. Percentage of patients participating in health education activities was high in Shandong Province［81.4%（613/753）］. Percentages of patients reading health education materials, visiting community clinic more than 4 times per year and having blood pressure self-monitoring were high in Beijing［71.6%（545/761）, 80.5%（613/761）, 77.1%（587/761）］. Patients in Jiangsu Province had higher percentages of antihypertensive therapy and drug combination than those in Shandong Province and Beijing［78.5%（595/758） vs 60.7%（457/753）, 71.7%（546/761）; 36.8%（279/758） vs 18.3%（138/753）, 26.4%（201/761）］; while they had lower percentages of low-salt diet, weight control and regular physical exercise（all P<0.05）. Blood pressure control rate in Beijing was 51.1%, which was higher than that in Jiangsu Province(47.9%) and Shandong Province(31.7%)(χ2=66.225， P＜0.001). Regular clinic visit(more than 7 times per year), blood pressure self-monitoring(1-3 times per month), reading health education materials, not drinking and regular physical exercise(more than 3 times per week) were positively correlated with blood pressure control rate（all P<0.05）. Conclusions    Health education, blood pressure self-monitoring and to public healthcare services are not popular in hypertension patients in China. There is a significant difference of blood pressure control situation among different cities. Healthy behaviors such as having clinic visit more than 7 times per year, self-monitoring blood pressure 1-3 times per month, reading health education materials, not drinking and having physical exercise are beneficial to increase the blood pressure control rate.