定期随访及综合干预对高血压患者疗效和费用影响

目的探讨定期随访、综合干预对健康体检中诊断为高血压病患者疗效和费用的影响。方法选择2007年1月~2009年1月在山东省青岛疗养院健康体检中心体检时确诊为高血压病的患者1 183例,按照分层随机分组法分为干预组和对照组。对干预组（587例）进行为期3年的定期随访及综合干预,对照组（596例）采用由患者自行管理,对治疗和行为不作要求,每年进行1次随访。使用SPSS 15.0统计分析软件对两组在降压效果和医疗费用等方面进行数据处理和统计分析,计量资料采用t检验,计数资料采用χ2检验,P〈0.05为差异有统计学意义。结果定期随访及综合干预3年后,干预组收缩压、舒张压、胆固醇、甘油三酯、血糖、血清肌酐和体质指数（BMI）值分别为（125±10.2）mm Hg、（79±11.2）mm Hg、（4.3±0.7）mmol/L、（1.52±0.5））mmol/L、（5.3±0.8））mmol/L、（93.2±12.5））mmol/L和（23.7±4.4）kg/m2,均低于对照组的（148±11.3）mm Hg、（98±11.4）mm Hg、（4.9±0.4））mmol/L、（4.9±0.4）mmol/L、（5.7±0.7）mmol/L、（99.5±15.8））mmol/L和（26.6±4.8）kg/m2,组间差异有统计学意义（t=37.037、28.865、5.262、2.173、2.661、2.110、3.149,P均〈0.05）。干预组饮食控制、参加体育活动、限酒和戒烟方面的比率（68.5%,71.9%,88.9%,87.4%）均高于对照组（37.2%,58.2%,49.3%,66.9%）,组间差异有统计学意义（χ2=17.94、30.62、220.62、71.18,P均〈0.01）;干预组高血压相关知识评分（7.69±1.77）分明显高于对照组（5.84±1.31）分,组间差异有统计学意义（t=20.457,P〈0.01）;干预组医疗费用较对照组明显下降（P〈0.01）。结论实施定期随访及综合干预,可以降低各种高血压危险因素,增加降压疗效和降压医疗费用。

Effect of regular follow-up and comprehensive intervention on the efficacy and medical cost in patients with primary hypertension

Objective To assess the effect of regular follow-up and comprehensive intervention on efficacy and medical cost in patients newly diagnosed with primary hypertension during physical check-up. Methods 1 183patients with primary hypertension diagnosed during physical check-up between January 2007and January 2009in Qingdao Sanatorium of Shandong province were enrolled into the study.They were randomly divided into intervention group（587）and control group（596）.Patients in intervention group were given regular follow-up and comprehensive intervention for three years,while those in control group were allowed for self managing but only followed up once a year.SPSS 15.0software was applied for data statistical analysis. Results After three years of regular follow-up and comprehensive intervention,the levels of systolic blood pressure,diastolic blood pressure,cholesterol,triglyceride,blood glucose,serum creatinine and body mass index（BMI）of patients were all significantly lower compared with those in control group（125±10.2 vs 148± 11.3mm Hg,79±11.2 vs 98±11.4mm Hg,4.3±0.7 vs 4.9±0.4mmol/L,1.52±0.5 vs 4.9±0.4 mmol/L,5.3±0.8 vs 5.7±0.7mmol/L,93.2±12.5 vs 99.5±15.8mmol/L,23.7±4.4 vs 26.6±4.8 kg/m2）（P〈0.05）.Also,compared to control group,more patients in intervention group were on diet（68.5%vs 37.2%）,active in physical exercise（71.9%vs 58.2%）,drank less or quitted smoking（88.9% vs 49.3%,87.4%vs 66.9%）（P〈0.01）（χ2=117.94,30.62,220.62and 71.18）.The score of awareness for hypertension-related knowledge among patients in intervention group（7.69±1.77）was significantly higher than that of the control group（5.84±1.31）,while the medical cost was much lower（P〈0.01）. Conclusions Regular follow-up and intervention for patients with primary hypertension can reduce the risk factors,enhance the therapeutic effects and decrease medical cost.