我国高血压社区综合干预效果的Meta分析
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摘要
目的研究和评价现阶段我国不同地区的高血压社区综合干预效果,为高血压社区干预方式的选择和优化提供依据。方法收集2009-2015年中国知网、万方、维普、中国生物医学文献等数据库相关文献,严格按照制定的纳入与排除标准选择文献。根据异质性检验结果,采用随机效应模型计算合并效应值,进行高血压社区综合干预总体效果的Meta分析;并分别以城乡、长江以南和以北地区进行亚组分析。结果最终纳入14篇文献。Meta分析结果显示,高血压干预效果的合并效应值为0.64(95%CI:0.60~0.68),差异有统计学意义(Z=32.61,P<0.001);城市和农村地区的合并效应值分别为0.66和0.57,差异均有统计学意义(均有P<0.001);长江以南和以北地区的合并效应值分别为0.63和0.64,差异均有统计学意义(均有P<0.001)。结论我国(城市或农村、长江以南或以北地区)高血压社区综合干预均存在明确的效果。
Objective To evaluate the effects of the integrated mode of community hypertension intervention in different regions of China at this stage and to provide evidences for selecting and optimizing the mode of community hypertension intervention in China. Methods Related articles published between 2009 and 2015 were searched through China national knowledge infrastructure( CNKI),VIP Chinese science and technology periodical database( VIP),wanfang data( Wanfang),Chinese biomedical literature database( CBM),and evaluated with the inclusion and exclusion criteria strictly. We used random effects model to calculate the effective size based on the result of heterogeneity analysis to evaluate total effect of integrated mode of community hypertension intervention with meta-analysis,and then conducted subgroup analysis based on region( urban and rural area,or the southern and northern area of the Yangtze River). Results A total of 14 articles met inclusion criteria. The results showed that the effective size of effect of integrated mode of community hypertension intervention was 0. 64( 95% CI: 0. 60-0. 68),the difference was statistically significant( Z = 32. 61,P < 0. 001); The effective size of urban and rural area were 0. 66 and 0. 57,the difference were statistically significant( P < 0. 001); The effective size of the southern and northern area were 0. 63 and 0. 64,the difference were statistically significant( P < 0. 001).Conclusion The effects of the integrated mode of community hypertension intervention in hina( including the urban or rural crea,the southern or northern area of the Yangtze river) is definite.
Objective To evaluate the effects of the integrated mode of community hypertension intervention in different regions of China at this stage and to provide evidences for selecting and optimizing the mode of community hypertension intervention in China. Methods Related articles published between 2009 and 2015 were searched through China national knowledge infrastructure( CNKI),VIP Chinese science and technology periodical database( VIP),wanfang data( Wanfang),Chinese biomedical literature database( CBM),and evaluated with the inclusion and exclusion criteria strictly. We used random effects model to calculate the effective size based on the result of heterogeneity analysis to evaluate total effect of integrated mode of community hypertension intervention with meta-analysis,and then conducted subgroup analysis based on region( urban and rural area,or the southern and northern area of the Yangtze River). Results A total of 14 articles met inclusion criteria. The results showed that the effective size of effect of integrated mode of community hypertension intervention was 0. 64( 95% CI: 0. 60-0. 68),the difference was statistically significant( Z = 32. 61,P < 0. 001); The effective size of urban and rural area were 0. 66 and 0. 57,the difference were statistically significant( P < 0. 001); The effective size of the southern and northern area were 0. 63 and 0. 64,the difference were statistically significant( P < 0. 001).Conclusion The effects of the integrated mode of community hypertension intervention in hina( including the urban or rural crea,the southern or northern area of the Yangtze river) is definite.
引文
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[17]沈启莹,王淑文,沈文俊,等.社区高血压患者综合干预效果分析[J].中国医师杂志,2009,11(7):943-945.
[18]姚爱红.社区全科医生对高血压病综合防治干预措施的影响[J].实用临床医药杂志,2013,17(19):123-124.
[19]王勇,王斯,陈晓平.高血压社区管理的现状及展望[J].中华高血压杂志,2015,23(7):630-632.
[20]Schapira MM,Fletcher KE,Hayes A,et al.The development and validation of the hypertension evaluation of lifestyle and management knowledge scale[J].J Clin Hypertens(Greenwich),2012,14(7):461-466.
[21]Campbell NR,Sheldon T.The Canadian effort to prevent and control hypertension:can other countries adopt Canadian strategies[J].Curr Opin in Cardiol,2010,25(4):366-372.
[22]陈伟伟.提高高血压控制率的关键是药物治疗还是血压管理[J].中华高血压杂志,2015,23(1):16-19.
[23]褚强强,唐海沁,夏光云.合肥市庐阳区高血压出院患者社区干预效果评价[J].中华疾病控制杂志,2015,19(10):1003-1005,1025.
[24]杨静,金翠香.老年高血压的社区护理干预效果与评价[J].中国老年学杂志,2007,27(13):1302-1303.
[25]周芳华,周吉,石健,等.广西南宁市高血压管理效果评价及城乡比较分析[J].中国临床新医学,2013,3(6):208-210.
[26]彭元,李平非,王晓玲,等.2010-2011年长沙市城乡社区高血压综合干预效果评估[J].实用预防医学,2012,19(11):1632-1635.
[27]安宁,王馨,武阳丰.北京市城乡社区卫生服务中心高血压防治现状的对比研究[J].中华心血管病杂志,2004,32(11):1021-1025.
[2]WHO.Nonocommunicable disease country profiles 2014[EB/OL].(2014-7-10)[2016-3-1].http://www.who.int/nmh/countries/en/.
[3]王琛琛,洪忻,秦真真,等.南京市社区高血压患者自我管理项目效果评估[J].中华疾病控制杂志,2016,20(10):975-978.
[4]刘建平.非随机研究的系统评价方法(一)[J].中国循证医学,2001,1(4):239-243.
[5]张武力.北京市怀柔区农村社区高血压综合干预效果观察[J].中国慢性病预防与控制,2009,17(4):395-397.
[6]王子林.社区综合干预1 068例高血压病效果评估[J].吉林医学,2010,31(36):6741-6742.
[7]张银娥,王晓莉,杨艺,等.社区高血压患者综合干预效果评价[J].宁夏医科大学学报,2013,35(4):407-411.
[8]李文奎.社区高血压患者综合治疗的疗效分析[J].吉林医学,2011,32(36):7783.
[9]高秀芹,吴向群,王静,等.高血压患者社区综合干预效果评估[J].中西医结合心脑血管病杂志,2009,7(7):770-771.
[10]陆燕,汤海英,吴武鑫,等.上海市奉贤区高血压患者社区干预结果分析[J].上海预防医学,2012,24(12):659-662.
[11]糜跃萍.对社区高血压患者实施综合干预管理的效果观察[J].临床和实验医学研究,2012,11(2):120-121.
[12]王彩霞,周志衡,王家骥,等.社区高血压病中西医结合综合干预效果评价[J].中华全科医学,2012,10(7):1113-1115.
[13]欧阳就红.综合干预对高血压控制的效果评价[J].中国社区医师(医学专业半月刊),2009,11(14):21-22.
[14]阮国强,陈凌炜.高血压病多因素社区干预效果分析[J].辽宁医学院学报,2011,32(5):422-424.
[15]冯维杰.高血压病患者社区综合干预的疗效评价[J].中国医药指南,2013,11(17):599-600.
[16]叶勤,沈小云,彭利花.高血压病社区干预的效果观察[J].社区医学杂志,2010,8(1):13-14.
[17]沈启莹,王淑文,沈文俊,等.社区高血压患者综合干预效果分析[J].中国医师杂志,2009,11(7):943-945.
[18]姚爱红.社区全科医生对高血压病综合防治干预措施的影响[J].实用临床医药杂志,2013,17(19):123-124.
[19]王勇,王斯,陈晓平.高血压社区管理的现状及展望[J].中华高血压杂志,2015,23(7):630-632.
[20]Schapira MM,Fletcher KE,Hayes A,et al.The development and validation of the hypertension evaluation of lifestyle and management knowledge scale[J].J Clin Hypertens(Greenwich),2012,14(7):461-466.
[21]Campbell NR,Sheldon T.The Canadian effort to prevent and control hypertension:can other countries adopt Canadian strategies[J].Curr Opin in Cardiol,2010,25(4):366-372.
[22]陈伟伟.提高高血压控制率的关键是药物治疗还是血压管理[J].中华高血压杂志,2015,23(1):16-19.
[23]褚强强,唐海沁,夏光云.合肥市庐阳区高血压出院患者社区干预效果评价[J].中华疾病控制杂志,2015,19(10):1003-1005,1025.
[24]杨静,金翠香.老年高血压的社区护理干预效果与评价[J].中国老年学杂志,2007,27(13):1302-1303.
[25]周芳华,周吉,石健,等.广西南宁市高血压管理效果评价及城乡比较分析[J].中国临床新医学,2013,3(6):208-210.
[26]彭元,李平非,王晓玲,等.2010-2011年长沙市城乡社区高血压综合干预效果评估[J].实用预防医学,2012,19(11):1632-1635.
[27]安宁,王馨,武阳丰.北京市城乡社区卫生服务中心高血压防治现状的对比研究[J].中华心血管病杂志,2004,32(11):1021-1025.