重庆地区部分老年高血压患者现况调查及多学科诊治方案建议
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摘要
目的:对重庆地区部分老年高血压患者进行现况调查,了解我市老年高血压患者患病情况、医疗情况和疾病管理情况。方法:采用描述性横断面调查研究,选取2016年2至6月在重庆医科大学附属第一医院老年科、心内科住院及青杠护养中心自理区入住的老年高血压患者共497例进行调查。结果:共收集有效问卷497例,血压达标率为55.73%。单因素分析时,年龄段、血压分级、饮酒史和就诊频率在血压达标组和未达标组之间差异有统计学意义。健康生活方式各指标完成率均在50%以上。高血压危险分层相关实验室检查基本项目及部分推荐项目阳性率高。仅24例调查对象(4.83%)为单纯高血压,473例调查对象(95.17%)有伴发疾病,最高伴发8种疾病。联合降压的调查对象有275例(55.33%),服用降压药种类最多为4种。结论:老年高血压患者存在多病共存、多重用药、治疗困难等特点,综合性医院应为老年高血压患者开设多学科诊治门诊,全面评估患者并制定合理完善的治疗方案。
Objective:To investigate the current status of elderly patients with hypertension in Chongqing,China,and to understand the prevalence,medical treatment,and disease management of elderly patients with hypertension. Methods:A descriptive cross-sectional study was performed for 497 elderly patients with hypertension who were admitted to Department of Geriatrics,Department of Cardiology,and Qinggang Nursing Center in The First Affiliated Hospital of Chongqing Medical University from February to June,2016.Results:A total of 497 usable questionnaires were collected,and the control rate of blood pressure was 55.73%. The univariate analysis showed that there were significant differences in age,blood pressure,drinking history,and frequency of hospital visits between the controlled blood pressure group and the uncontrolled blood pressure group. The completion rates of healthy lifestyle indicators were above 50%. There were high positive rates of the basic items and some recommended items in the laboratory examination for risk classification of hypertension. Of all respondents,24(4.83%) had simple hypertension and 473(95.17%) had concomitant diseases,with the highest number of 8 concomitant diseases. Of all respondents,275(55.33%) were treated with more than one antihypertensive drug,with the highest number of 4 drugs. Conclusion:Elderly patients with hypertension are characterized by the coexistence of multiple diseases,multiple drug use,and difficulties in treatment. Comprehensive hospitals should set up a multidisciplinary diagnosis and treatment mode for elderly hypertensive patients,in order to provide comprehensive evaluations and reasonable treatment regimens.
Objective:To investigate the current status of elderly patients with hypertension in Chongqing,China,and to understand the prevalence,medical treatment,and disease management of elderly patients with hypertension. Methods:A descriptive cross-sectional study was performed for 497 elderly patients with hypertension who were admitted to Department of Geriatrics,Department of Cardiology,and Qinggang Nursing Center in The First Affiliated Hospital of Chongqing Medical University from February to June,2016.Results:A total of 497 usable questionnaires were collected,and the control rate of blood pressure was 55.73%. The univariate analysis showed that there were significant differences in age,blood pressure,drinking history,and frequency of hospital visits between the controlled blood pressure group and the uncontrolled blood pressure group. The completion rates of healthy lifestyle indicators were above 50%. There were high positive rates of the basic items and some recommended items in the laboratory examination for risk classification of hypertension. Of all respondents,24(4.83%) had simple hypertension and 473(95.17%) had concomitant diseases,with the highest number of 8 concomitant diseases. Of all respondents,275(55.33%) were treated with more than one antihypertensive drug,with the highest number of 4 drugs. Conclusion:Elderly patients with hypertension are characterized by the coexistence of multiple diseases,multiple drug use,and difficulties in treatment. Comprehensive hospitals should set up a multidisciplinary diagnosis and treatment mode for elderly hypertensive patients,in order to provide comprehensive evaluations and reasonable treatment regimens.
引文
[1]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
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[3]中华医学会老年医学分会,中国医师协会高血压专业委员会.老年高血压特点与临床诊治流程专家建议[J].中华高血压杂志,2014,22(7):620-628.
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[6]王陇德.健康管理师:国家职业资格三级[M].北京:人民卫生出版社,2013:124-147.
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[9]林凡礼,战义强,贾贡献,等.中国门诊高血压患者血压达标现状及影响因素分析[J].中华高血压杂志,2013,21(2):170-174.
[10]张玉玲,宋成为,王希香,等.老年高血压患者血压达标情况及影响因素[J].中国老年学杂志,2015,35(24):7066-7067.
[11]张晓文.某社区高血压病患者血压达标影响因素分析[J].人民军医,2016,59(12):1248-1250.
[12]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[13]马洪武,陈杰,范冉,等.慢性病规范管理对原发性高血压的疗效观察[J].心肺血管病杂志,2016,35(8):603-605.
[14]邱夏芹,薛燕.护理干预对老年高血压病患者的效果评价[J].吉林医学,2013,34(12):2389-2390.
[15] Leung AA,Nerenberg K,Daskalopoulou SS,et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement,diagnosis,assessment of risk,prevention,and treatment of hypertension[J]. Can J Cardiol,2016,32(5):569-588.
[16] Mancia G,Fagard R,Narkiewicz K,et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J]. J Hypertens,2013,31(7):1281-1357.
[17]葛彩英.北京市方庄社区慢性病管理情况调查[J].中国全科医学,2011,14(4):426-427.
[18]魏学娟,吴浩,于海洋,等.方庄社区家庭医生式服务推进分级诊疗的实践效果研究[J].中国全科医学,2017,20(13):1558-1563.
[19]王文,张维忠,孙宁玲,等.中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.
[20] Su TT,Majid HA,Nahar AM,et al. Correction to:the effectiveness of a lifestyle modification and peer support home blood pressure monitoring in control of hypertension:protocol for a cluster randomized controlled trial[J]. BMC Public Health,2017,17(1):864.
[21]葛彩英,孔慜,赵新颖,等.家庭自测血压对高血压患者血压达标和血压波动性的评价研究[J].中国全科医学,2012,15(9):2884-2888.
[22]中国医师协会高血压专业委员会,中国高血压联盟,中华医学会心血管病学分会.家庭血压监测中国专家共识[J].中华高血压杂志,2012,20(6):525-529.
[23]李玉青,曹远,刘秀荣.北京市居民家庭血压计配备及使用情况调查[J].中国全科医学,2014,17(32):3865-3867.
[24]黄文蔚,徐红新,吕永楠,等.高血压合并多重心血管病危险因素的治疗现状及其影响[J].武汉大学学报(医学版),2011,32(3):374-377.
[25] Kuo MC,Jeng C,Chen CM,et al. Pro覲le of elderly with multiple physician visits:advocacy for tailored comprehensive geriatric assessment use in clinics[J]. Geriatr Gerontol Int,2014,14(2):372-380.
[26]葛楠,朱鸣雷,曲璇,等.老年整合门诊的构建及效果分析[J].中国实用内科杂志,2016,36(1):46-48.
[27]滕晋,王丹,徐熙,等.老年患者多重用药调查及共病管理的临床策略[J].中国卫生事业管理,2015,32(9):695-697.
[28]薛自立,李辉.老年住院患者的用药调查[J].中国临床研究,2012,25(1):79.
[29]金福碧,郑和昕,林玲萍,等.老年住院患者多重用药调查分析与对策[J].浙江中医药大学学报,2012,36(12):1360-1363.
[30]杨明珠,李娜.老年人多重用药的认知管理研究进展[J].中国老年学杂志,2015,35(6):1715-1717.
[2] Lewington S,Lacey B,Clarke R,et al. The burden of hypertension and associated risk for cardiovascular mortality in China[J]. JAMA Intern Med,2016,176(4):524-532.
[3]中华医学会老年医学分会,中国医师协会高血压专业委员会.老年高血压特点与临床诊治流程专家建议[J].中华高血压杂志,2014,22(7):620-628.
[4]国家卫生计生委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2015:33-50.
[5]中国老年学和老年医学学会心脑血管病专业委员会,中国医师协会心血管内科医师分会.老年高血压的诊断与治疗中国专家共识(2017版)[J].中华内科杂志,2017,56(11):885-893.
[6]王陇德.健康管理师:国家职业资格三级[M].北京:人民卫生出版社,2013:124-147.
[7]国家心血管病中心.国家基层高血压防治管理指南(2017)[EB/OL]. http://www.nccd.org.cn/Sites/Uploaded/File/2018/4/%E5%9B%BD%E5%AE%B6%E5%9F%BA%E5%B1%82%E9%AB%98%E8%A1%80%E5%8E%8B%E7%AE%A1%E7%90%86%E6%8C%87%E5%8D%9716%E5%BC%80.pdf
[8]李芳,郭燕,王亮,等.武汉市≥65岁老年人高血压患病率、知晓率与控制率[J].中华高血压杂志,2014,22(7):651-655.
[9]林凡礼,战义强,贾贡献,等.中国门诊高血压患者血压达标现状及影响因素分析[J].中华高血压杂志,2013,21(2):170-174.
[10]张玉玲,宋成为,王希香,等.老年高血压患者血压达标情况及影响因素[J].中国老年学杂志,2015,35(24):7066-7067.
[11]张晓文.某社区高血压病患者血压达标影响因素分析[J].人民军医,2016,59(12):1248-1250.
[12]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[13]马洪武,陈杰,范冉,等.慢性病规范管理对原发性高血压的疗效观察[J].心肺血管病杂志,2016,35(8):603-605.
[14]邱夏芹,薛燕.护理干预对老年高血压病患者的效果评价[J].吉林医学,2013,34(12):2389-2390.
[15] Leung AA,Nerenberg K,Daskalopoulou SS,et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement,diagnosis,assessment of risk,prevention,and treatment of hypertension[J]. Can J Cardiol,2016,32(5):569-588.
[16] Mancia G,Fagard R,Narkiewicz K,et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J]. J Hypertens,2013,31(7):1281-1357.
[17]葛彩英.北京市方庄社区慢性病管理情况调查[J].中国全科医学,2011,14(4):426-427.
[18]魏学娟,吴浩,于海洋,等.方庄社区家庭医生式服务推进分级诊疗的实践效果研究[J].中国全科医学,2017,20(13):1558-1563.
[19]王文,张维忠,孙宁玲,等.中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.
[20] Su TT,Majid HA,Nahar AM,et al. Correction to:the effectiveness of a lifestyle modification and peer support home blood pressure monitoring in control of hypertension:protocol for a cluster randomized controlled trial[J]. BMC Public Health,2017,17(1):864.
[21]葛彩英,孔慜,赵新颖,等.家庭自测血压对高血压患者血压达标和血压波动性的评价研究[J].中国全科医学,2012,15(9):2884-2888.
[22]中国医师协会高血压专业委员会,中国高血压联盟,中华医学会心血管病学分会.家庭血压监测中国专家共识[J].中华高血压杂志,2012,20(6):525-529.
[23]李玉青,曹远,刘秀荣.北京市居民家庭血压计配备及使用情况调查[J].中国全科医学,2014,17(32):3865-3867.
[24]黄文蔚,徐红新,吕永楠,等.高血压合并多重心血管病危险因素的治疗现状及其影响[J].武汉大学学报(医学版),2011,32(3):374-377.
[25] Kuo MC,Jeng C,Chen CM,et al. Pro覲le of elderly with multiple physician visits:advocacy for tailored comprehensive geriatric assessment use in clinics[J]. Geriatr Gerontol Int,2014,14(2):372-380.
[26]葛楠,朱鸣雷,曲璇,等.老年整合门诊的构建及效果分析[J].中国实用内科杂志,2016,36(1):46-48.
[27]滕晋,王丹,徐熙,等.老年患者多重用药调查及共病管理的临床策略[J].中国卫生事业管理,2015,32(9):695-697.
[28]薛自立,李辉.老年住院患者的用药调查[J].中国临床研究,2012,25(1):79.
[29]金福碧,郑和昕,林玲萍,等.老年住院患者多重用药调查分析与对策[J].浙江中医药大学学报,2012,36(12):1360-1363.
[30]杨明珠,李娜.老年人多重用药的认知管理研究进展[J].中国老年学杂志,2015,35(6):1715-1717.