高血压患者遵医行为的调查研究

目的了解高血压患者的遵医行为并提出相应对策。方法采用自行设计的高血压患者遵医行为调查问卷对60例患者进行调查。结果20.0%患者能完全遵医按时服药,25.0%患者能完全遵医定期监测血压,38.3%患者能完全遵医坚持合理饮食,18.3%患者能完全遵医戒烟限酒,60.0%患者能遵医坚持药物治疗,48.3%患者能遵医坚持适量运动。结论高血压病患者遵医行为较差,医护人员应重视高血压病患者的健康教育工作,采取相应措施,加强患者遵医行为,减少并发症的发生,提高高血压患者的生存质量。     

健康教育对高血压患者遵医行为影响的Meta分析

目的:采用Meta分析的方法就健康教育对高血压患者遵医行为的影响进行探讨。方法:检索主要医学数据库,按照一定的纳入和排除标准筛选文献并进行质量评价。采用Review Manager v5.0软件就正确服药、合理膳食、适量运动、戒烟限酒、情绪调节、监测血压、降低体重等7个方面就健康教育对高血压患者遵医行为的影响进行综合评价。结果:在高血压患者遵医行为的7个方面,健康教育组与对照组差异均有统计学意义(P0.01)。结论:常规治疗护理基础上针对高血压患者及其家属进行的健康教育可以改善患者的遵医行为,应予以推广。     

乌鲁木齐南山牧区哈萨克族原发性高血压患者遵医行为调查及影响因素分析

目的 探讨乌鲁木齐南山牧区哈萨克族原发性高血压患者遵医行为现状及影响因素,并提出相应的护理对策.方法 采用自编原发性高血压患者遵医行为调查问卷对625例哈萨克族原发性高血压患者进行调查,并对结果进行分析.结果 4.3%患者能遵医坚持药物治疗,90.2%患者能遵医坚持运动治疗,2.5%患者能遵医坚持合理饮食,14.4%患者能遵医戒烟,30.3%患者能遵医戒酒,3.8%患者能遵医坚持门诊随访.患者的遵医行为主要与其年龄、忘记服药、认为疾病好转而停药、生活方式的改变难以做到等原因有关(P＜0.01).结论 提高患者原发性高血压相关知识的知晓率,加强原发性高血压患者健康教育,简化治疗方案,争取家庭社会的支持等护理方案有利于提高哈萨克族原发性高血压患者的遵医行为.     

影响冠心病患者健康行为的调查与分析

目的 调查冠心病患者健康行为(合理膳食、适量运动、戒烟限酒、心理平衡、遵医服药等)的状况,并分析其影响因素,为今后提高冠心病患者的健康教育作参考.方法 对60例冠心病患者,通过自行设计的调查问卷以访谈的方式对其进行调查.结果 冠心病患者健康行为状况中等以上者占88.3%,差者占11.7%.51岁以下患者的健康行为状况较51岁以上者差;退休组患者的健康行为状况较在职者好;肥胖者健康行为状况最差,其次为体重正常者,超重者健康行为状况最好.结论 健康教育重点应放在低盐、低脂饮食;如何采取合理的心理应对机转;随身携带应急药物的必要性,完全遵医嘱服药的重要性;自我监测应监测什么,监测频率;复查的意义等知识上.     

社区护理对冠心病合并高脂血症患者遵医行为的影响

目的探讨社区护理干预对冠心病(CHD)合并高脂血症患者遵医行为的影响。方法将110例CHD合并高脂血症患者随机分为干预组(55例)和对照组(55例)。干预组实施社区护理干预:嘱其合理饮食、适量运动锻炼、精神放松、戒烟限酒、定期复诊和按时服药;对照组不实施社区护理干预。采用问卷调查的方式评估两组患者的遵医情况。结果干预组在合理饮食、运动锻炼、精神放松和戒烟限酒、定期复诊与按时服药方面的遵医率较对照组高(P<0.01或P<0.05)。结论社区护理干预可以提高CHD合并高脂血症患者的遵医率,从而提高这些患者的疗效。     

社区护理学

070153社区护理对冠心病合并高脂血症患者遵医行为的影响/陈洁清…//护理学报.-2006,13(10).-57~58将110例冠心病(CHD)合并高脂血症患者随机分为干预组(55例)和对照组(55例)。干预组实施社区护理干预:嘱其合理饮食、适量运动锻炼、精神放松、戒烟限酒、定期复诊和按时服药;对照组不实施社区护理干预。采用问卷调查的方式评估两组患者的遵医情况。结果:干预组在合理饮食、运动锻炼、精神放松和戒烟限酒、定期复诊与按时服药方面的遵医率较对照组高(P<0.01或P<0.05)。提示:社区护理干预可以提高CHD合并高脂血症患者的遵医率,从而提高这些…     

社区护士在提高老年高血压患者生活质量中的作用

目的:探讨社区护士在提高老年高血压患者生活质量中的作用。方法:将216例老年高血压患者随机分为实验组和对照组各108例,实验组患者在接受必要的药物治疗的同时,社区护士从心理、饮食、运动、服药及生活习性等方面给予健康指导,而对照组患者不接受系统的健康指导,只给予必要的药物治疗。12个月对两组患者进行随访。结果:实验组患者的主要生活行为,包括戒烟、限酒、低盐饮食和适当运动等明显优于对照组(P<0.01);实验组患者的服药依从性、在定期复查、遵医嘱调整药物剂量等方面明显高于对照组(P<0.01)。结论:社区护士对老年高血压患者健康指导作为一项科学的护理措施,可提高老年高血压患者的遵医行为,能够促使患者尽快改进不良生活习惯,有效提高服药依从性,养成有益健康的生活方式,提高了生活质量。     

健康教育对出院高血压病病人遵医行为的影响

[目的]为了解出院高血压病病人的遵医行为及健康教育对出院高血压病病人遵医行为的影响。[方法]将2007年2月—2007年12月在我院住院的高血压病病人100例随机分为实验组与对照组,每组50例。对实验组病人进行系统的健康教育。6个月后从正确服药、合理饮食、监测血压、戒烟限酒、适量运动及保持良好心态方面对两组病人进行调查。[结果]实验组病人除戒烟限酒与对照组比较无统计学意义,其余与对照组比较差异均有统计学意义。[结论]对出院高血压病病人实施健康教育,有助于提高高血压病病人的遵医行为。     

健康教育对出院高血压病病人遵医行为的影响

[目的]为了解出院高血压病病人的遵医行为及健康教育对出院高血压病病人遵医行为的影响。[方法]将2007年2月—2007年12月在我院住院的高血压病病人100例随机分为实验组与对照组,每组50例。对实验组病人进行系统的健康教育。6个月后从正确服药、合理饮食、监测血压、戒烟限酒、适量运动及保持良好心态方面对两组病人进行调查。[结果]实验组病人除戒烟限酒与对照组比较无统计学意义,其余与对照组比较差异均有统计学意义。[结论]对出院高血压病病人实施健康教育,有助于提高高血压病病人的遵医行为。     

青壮年高血压患者遵医行为现状调查

目的 了解青壮年高血压患者遵医行为的现状.方法 采用自行设计的问卷对青壮年高血压患者在服药、饮食、睡眠、运动、自我监测、寻求健康帮助等方面情况进行调查.结果 青壮年高血压患者遵医行为不佳,主要表现在以下方面：不注重运动,不能做到定时、定量运动;近半患者不能按时、按量、按种类服药;大多患者没有定期到医疗单位监测血压和自我监测症状.本组患者三餐规律、食量适中遵医行为较好.结论 应加强对青壮年高血压患者的健康宣教,积极创造条件,改进青壮年高血压患者的遵医行为,从而提高患者远期的生活质量和健康水平.     

高血压并发脑卒中危险因素分析及行为干预对策研究

目的 :寻找高血压病 (EH)并发脑卒中的危险因素 ,提出预防脑卒中发生的行为干预对策。方法 :EH并发急性脑卒中患者 10 2例 (EH脑卒中组 ) ,另选性别、年龄与 EH脑卒中组配对的 10 2例单纯高血压病患者(EH组 )和 10 2例健康人 (正常对照组 )作为对照。测量并记录全部受试者收缩压 (SBP)、舒张压 (DBP)、体重指数 (BMI)、腰臀比 (WHR) ;按照流行病学调查方法调查统计生活习惯、膳食、饮酒、精神心理等方面情况。结果 :EH组和 EH脑卒中组饮酒、膳食偏咸、打鼾、易激动者较正常对照组多 ,锻炼者少 ,且血压、WHR显著增高 ,BMI、血脂无显著差别 ;EH脑卒中组吸烟、膳食口味偏咸者较 EH组多 ,锻炼者少 ,且血压、WHR显著增高。逐步 L ogistic回归分析显示 ,与脑卒中发生关联密切的是 SBP、WHR增高和锻炼少。结论 :戒烟酒、低盐饮食、增加锻炼、保持心理平衡对 EH和脑卒中都有重要防治作用 ;有效降压治疗 (尤其是降低 SBP)、控制体重 (尤其是降低 WHR)和增加锻炼对预防脑卒中的发生有特别重要的临床意义。     

个性化社区护理对老年原发性高血压患者治疗依从性和生活质量的影响

目的 探讨个性化社区护理对老年原发性高血压患者治疗依从性和生活质量的影响。方法 选取2013年5月-2014年5月社区老年原发性高血压患者120例,按奇偶数分为对照组和观察组各60例。对照组采用常规护理,观察组采用个性化社区护理,比较2组患者的生活不良行为、治疗依从性以及血压变化情况。结果 观察组戒烟、饮酒、限制食盐摄入、体质量控制均好于对照组,服药依从性明显高于对照组(Z=-2.894,P=0.004),血压控制情况好于对照组。结论 个性化社区护理明显改善了患者的不良生活习惯,提高了患者的治疗依从性,降压效果明显。     

Health guidance for patients with mild hypertension

Hypertension is the most common lifestyle related disease in Japan. Among the lifestyle modifications, salt restriction is most important especially in Japanese hypertensive patients. Although Japanese as well as international guidelines recommend the restriction of salt intake less than 6 g/day, our report suggests that very few Japanese hypertensive patients achieve this goal. Other lifestyle modifications include the increased intake of vegetables and fruits, maintenance of appropriate body weight, regular exercise, the restriction of alcohol intake and cessation of smoking. It is emphasized that comprehensive lifestyle modification is more effective. Since the long term compliance of lifestyle modification is difficult especially in the patients with mild hypertension, continuous encouragement and support should be done at the opportunity of health screening or health guidance.     

110例高血压患者药物治疗依从性相关因素分析

[目的]探讨影响高血压患者药物治疗依从性的相关因素。[方法]根据依从性评判标准对110例高血压患者应用降压药物治疗情况评价,分析依从性好与依从性差两组患者性别、年龄、高血压知识、对医疗水平信任程度、高血压病程、药物副作用、服药种类等方面的差异。[结果]110患者中口服降压药物依从性好60例（54．54％）,依从性差50例（45．45％）;依从性差组缺少高血压知识（42．00％）、对医疗水平不信任（34．00％）、存在降压药物不良反应（38．00％）、年龄[（63．45＆#177;12．89）岁]、服药种类[（2．12＆#177;0．52）种]分别高于依从性好组的16．67％、10．00％、8．33％、（50．45＆#177;13．67）岁、（1．45＆#177;0．29）种（ P ＜0．05）,是影响药物治疗依从性的相关因素。[结论]高血压患者药物治疗依从性差,影响因素复杂,应加强对患者相关药物治疗宣教,尽可能降低用药方案的复杂性以提高依从性。     

社区护理干预对老年高血压病患者的影响

目的了解社区护理干预对高血压病患者的影响。方法2006年1月～2007年1月对本社区≥60岁的92例老年高血压病患者采取护理干预措施，包括合理饮食、限盐、适当运动、禁烟酒、控制体重及药物等方面的健康教育指导，于干预前及干预后1年对患者进行问卷调查。结果干预前后患者生活方式（限盐、运动、吸烟、饮酒及体重控制）比较，差异均有统计学意义（均P〈0．01）；干预前后患者对疾病知识的知晓率、服药依从性、血压控制率比较。均有统计学意义（均P〈0．01）；干预后患者收缩压和舒张压与干预前比较，差异均有统计学意义（均P〈0．01）。结论实施社区护理干预能提高高血压病患者自我保健意识和保健能力，有效地控制血压，改善预后，从而提高患者的生活质量。     

老年高血压病患者停服降压药物的原因分析

目的为了调查老年高血压病患者停服降压药物的原因,以提高老年高血压患者的治疗效果.方法采用面谈和查阅患者病历的方法,调查115例高血压病患者停服降压药物的原因及其动态血压检测结果,然后进行数据统计和分析.结果 115例停服降压药物的原因分别为多次测量血压偏低、对高血压病了解不够、对降压药物了解不够、服药方案过于复杂、老年患者记忆力较差、一时配不到同种药物,其中因血压偏低而停药患者(血压控制率为77.35%)与因其他原因而停药患者(血压控制率为33.87%)比较,差异有统计学意义(P＜0.001).结论对患者加强健康教育,定期检测血压,以提高血压控制率.     

Prevalence of and risk factors for isolated systolic hypertension in the rural adult population of Liaoning Province, China

The prevalence of and associated risk factors for isolated systolic hypertension, as defined by the Joint National Committee (JNC)-6 classification, were investigated in the rural population of Liaoning Province, China. A total of 45,925 people aged 35 years or older were examined in a cross-sectional study. Overall, the prevalence of isolated systolic hypertension was 10.6% (males 10.1%; females 11.2%). The prevalence of isolated systolic hypertension was positively correlated with age, gender, smoking status, alcohol intake, body mass index, salt intake and Mongolian race. This study showed that isolated systolic hypertension was very common in rural Chinese people and that many risk factors are linked with isolated systolic hypertension.     

The future of antihypertensive treatment

Despite progress in recent years in the prevention, detection, and treatment of high blood pressure (BP), hypertension remains an important public health challenge. Hypertension affects approximately 1 billion individuals worldwide. High BP is associated with an increased risk of mortality and morbidity from stroke, coronary heart disease, congestive heart failure, and end-stage renal disease; it also has a negative impact on the quality of life. Hypertension cannot be eliminated because there are no vaccines to prevent the development of hypertension, but, its incidence can be decreased by reducing the risk factors for its development, which include obesity, high dietary intake of fat and sodium and low intake of potassium, physical inactivity, smoking, and excessive alcohol intake. For established hypertension, efforts are to be directed to control BP by lifestyle modification (LSM). However, if BP cannot be adequately controlled with LSM, then pharmacotherapy can be instituted along with LSM. Normalization of BP reduces cardiovascular risk (for cardiovascular death, myocardial infarction, and cardiac arrest), provides renoprotection (prevention of the onset or slowing of proteinuria and progression of renal dysfunction to end-stage renal disease in patients with hypertension, diabetes mellitus types 1 and 2, and chronic renal disease), and decreases the risk of cerebrovascular events (stroke and cognition impairment), as has been amply demonstrated by a large number of randomized clinical trials. In spite of the availability of more than 75 antihypertensive agents in 9 classes, BP control in the general population is at best inadequate. Therefore, antihypertensive therapy in the future or near future should be directed toward improving BP control in treated hypertensive patients with the available drugs by using the right combinations at optimum doses, individually tailored gene-polymorphism directed therapy, or development of new modalities such as gene therapy and vaccines.Several studies have shown that BP can be reduced by lifestyle/behavior modification. Although, the reductions appear to be trivial, even small reductions in systolic BP (for example, 3-5 mm Hg) produce dramatic reduction in adverse cardiac events and stroke. On the basis of the results of clinical and clinical/observational studies, it has been recommended that more emphasis be placed on lifestyle/behavior modification (obesity, high dietary intake of fat and sodium, physical inactivity, smoking, excessive alcohol intake, low dietary potassium intake) to control BP and also to improve the efficacy of pharmacologic treatment of high BP. New classes of antihypertensive drugs and new compounds in the established drug classes are likely to widen the armamentarium available to combat hypertension. These include the aldosterone receptor blockers, vasodilator beta-blockers, renin inhibitors, endothelin receptor antagonists, and dual endopeptidase inhibitors. The use of fixed-dose combination drug therapy is likely to increase.There is a conceptual possibility that gene therapy may yield long-lasting antihypertensive effects by influencing the genes associated with hypertension. But, the treatment of human essential hypertension requires sustained over-expression of genes. Some of the challenging tasks for successful gene therapy that need to be mastered include identification of target genes, ideal gene transfer vector, precise delivery of genes into the required site (target), efficient transfer of genes into the cells of the target, and prompt assessment of gene expression over time. Targeting the RAS by antisense gene therapy appears to be a viable strategy for the long-term control of hypertension. Several problems that are encountered in the delivery of gene therapy include 1) low efficiency for gene transfer into vascular cells; 2) a lack of selectivity; 3) problem in determining how to prolong and control transgene expression or antisense inhibition; and 4) difficulty in minimizing the adverse effects of viral or nonviral vectors. In spite of the hurdles that face gene therapy administration in humans, studies in animals indicate that gene therapy may be feasible in treating human hypertension, albeit not in the near future. DNA testing for genetic polymorphism and determining the genotype of a patient may predict response to a certain class of antihypertensive agent and thus optimize therapy in individual patients. In this regard, there are some studies that report the effectiveness of antihypertensive therapy based upon the genotype of selected patients. Treatment of human hypertension with vaccines is feasible but is not likely to be available in the near future.     

原发性高血压患者治疗依从性与生活质量

背景原发性高血压患者治疗依从性直接影响其病情的发展和治疗的效果,但原发性高血压患者治疗依从性与生活质量的关系又是什么呢?目的探讨原发性高血压患者治疗依从性与生活质量的关系.设计回顾性调查研究.地点、对象和方法主要采用治疗依从性问卷、简明健康测量量表对339例住院原发性高血压患者的院外情况进行回顾性调查.主要观察指标引入生活质量评价技术指标,结合患者的治疗依从性,分析其相关性.结果服药依从性与生活质量各个因子及总分呈正相关(r=0.15～0.21,P＜0.05).门诊随访与生活质量各个因子及生活质量总分呈负相关(r=-0.11～-0.13,P＜0.05).戒烟、戒酒或少饮酒、饮食、运动和控制体质量等5项生活方式依从性及总分与生活质量各个因子呈正相关(r=0.11～0.21,P＜0.05).患者服药依从性好的占39.80%、门诊随访占63.70%、5项生活方式依从性占34.20%,其中戒烟占86.70%、戒酒或少饮酒占79.10%、饮食占70.80%、运动占68.10%和控制体质量54.00%.结论原发性高血压患者治疗依从性与生活质量间存在密切相关.     

Hypertension

An estimated 58 million Americans are at increased risk of morbidity and premature death due to high blood pressure (BP) and require some type of therapy or systematic monitoring. This article focuses on recent advances in our understanding of the pathogenesis of hypertension, new approaches to the diagnosis and treatment of secondary hypertension, and current views of the most appropriate nonpharmacologic and pharmacologic therapy for essential hypertension. In view of the extremely high prevalence of the disorder, emphasis is placed on efficient and cost-effective strategies for diagnosing and managing the hypertensive patient. Recent evidence indicates that nonpharmacologic therapy, including dietary potassium and calcium supplements, reduction of salt intake, weight loss for the obese patient, regular exercise, a diet high in fiber and low in cholesterol and saturated fats, smoking cessation, and moderation of alcohol consumption produces significant sustained reductions in BP while reducing overall cardiovascular risk. Accordingly, nonpharmacologic antihypertensive therapy should be included in the treatment of all hypertensive patients. In persons with mild hypertension, nonpharmacologic approaches may adequately reduce BP, thereby avoiding the expense and potential side effects of drug therapy. In patients with more severe hypertension, nonpharmacologic therapy, used in conjunction with pharmacologic therapy, can reduce the dosage of antihypertensive medications necessary for BP control. Patients treated with nonpharmacologic therapy only should be followed closely, and if BP control is not satisfactory, drug therapy should be added. The large number of drugs available for use in hypertension treatment, coupled with our rapidly expanding knowledge of the pathophysiology of hypertension and of the adverse effects of these drugs in individual patient groups, make it possible to individualize antihypertensive treatment. When used as monotherapy, most agents effectively lower BP in the majority of patients with mild or moderate essential hypertension. Thus, a single agent from one of four classes: diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers, usually provides effective BP control with minimal side effects in most patients. Therapy should be initiated with the agent most likely to be effective in BP lowering and best tolerated. If the initial agent is ineffective at maximal recommended therapeutic doses or has undue side effects, an alternative agent from another class should be tried. When monotherapy is unsuccessful, a second agent, usually of a different mechanism of action, should be