高血压患者社区自我管理模式效果分析

目的探讨社区高血压患者建立自我管理小组开展健康自我管理的效果，为该地区建立科学、系统的高血压防治体系提供依据。方法2013年，在昆山市农村和城镇社区对220例高血压患者进行6个月的自我管理，并对管理效果进行分析。结果220例高血压患者，通过高血压自我管理活动，对高血压的诊断标准、理想血压值、危险因素、药物和非药物治疗等相关知识的知晓率分别较管理前显著提高，差异有统计学意义（P〈0．01）；每周进行规律性中等强度运动、每天坚持增加蔬菜和水果的摄入量、限盐饮食、规范测压、规范服药的患者比例管理前后分别为51．36％、54．55％、60．00％、76．36％、65．00％和79．55％、84．55％、98．64％、94．09％、88．64％，差异均有统计学意义（均P〈0．01）；吸烟的人数明显下降，管理前后患者吸烟比例分别为38．18％和11．82％（P〈0．01）；血压的控制率管理前后分别为71．36％和93．64％；居家购买血压计、每周测量血压者的比例显著增加，管理前后分别为26．36％和43．64％（P〈0．05）；对自我管理模式的认可比例管理前后分别为34．55％和98．18％（P〈0．01）。结论开展高血压自我管理，提高了高血压患者高血压相关知识的知晓率，促进了其不良生活行为方式的改变，提高了服药依从性和血压控制合格率，增强了高血压管理需求和患者自我效能，该方法是一种可行、有效、高效率的疾病管理模式。

Effect of self management model among hypertensive patients in community

[ Objective ] To investigate the effect of health self management among hypertensive patients in community, provide basis for establishing a scientific and systematic hypertension prevention and control system. [ Methods] Self management was carried out for 6 months among 220 hypertensive patients in rural and urban communities in Kunshan city, the effect of management was ana- lyzed. [ Results] After the self management activities, the awareness of hypertension diagnostic standard, ideal blood pressure, risk factors, drugs and non-drug therapy and other related knowledge among 220 hypertensive patients were increased significantly than before （ P 〈 0.01 ）. The proportion of patients with regular medium strength exercise per week, adding the intake of fruits and vege- tables every day, a salt restricted diet, standard measuring blood pressure, medicine taking regularly before and after management were 51.36%, 54.55%, 60.00%, 76.36%, 65.00% and 79.55%, 84.55%, 98.64%, 94.09%, 88.64%, the differences were statistically significant （ P 〈 0.01 ）. The smoking rates before and after management were 38.18% and 11.82% （P 〈 0.01 ）. Hypertension control rates were 71.36% and 93.64% before and after management. Purchasing blood pressure cuff, measuring blood pressure weekly were increased, the proportion were 26.36% and 43.64% before and after management （P 〈 0.05 }. The approval rates of self management were 34.55% and 98.18% before and after management （ P 〈 0.01）. [ Conclusion] The self management of hypertension improves the awareness rate of hypertension related knowledge of hypertensive patients, promotes the change of bad behavior and life style, increases the medication compliance and qualified rate of blood pressure control, enhances the managing demand and patients self-efficacy. This method is a feasible, effective, and high efficiency diseases management mod- el