成都市高血压人群在社区规范化管理中实施非药物治疗的效果研究

目的探讨高血压疾病在社区规范化管理中非药物治疗的实施效果。方法2010年10月-2011年10月，选取成都市成华区14家社区卫生服务中心的全科医生共33名，依据2009年基层版《中国高血压防治指南》对社区医生进行高血压规范化管理培训，培训后每名医生按1：25的比例对社区内的高血压患者实行为期1年的规范化管理，评估非药物治疗实施情况以及降压效果。结果共纳入分析的高血压患者632例，年龄36～79岁，平均（65．72±8．55）岁。进行高血压规范化管理前，患者对非药物治疗措施戒烟、限酒、限盐、减重、增加体育锻炼的接受率依次是75．96％、71．43％、99．01％、73．28％、85．00％。规范化管理1年后，高血压患者吸烟、饮酒、饮食偏咸、超重肥胖和缺乏体育锻炼所占比例由8．54％、5．54％、16．00％、55．06％、23．73％降至3．80％、1．42％、2．69％、34．34％、11．39％，管理前后比较差异有统计学意义（P〈0．001）；非药物治疗、药物治疗和非药物＋药物治疗患者收缩压分别下降25．81、23．71、27．78mmHg（1mm Hg=0．133kPa），舒张压分别下降10．23、3．99、10．46mmHg，3种方式血压下降情况比较差异均有统计学意义（P〈0．05）。结论全科医生对社区高血压患者实行规范化管理，其非药物治疗措施实施效果得到提高，血压控制良好。

A Community-based Study of Non-pharmaceutical Therapy in Patients with Hypertension in Chengdu

Objective To explore the effect of non-pharmaceutical therapy in patient with hypertension in Chengdu. Methods From October 2010 to October 2011, a total of 33 general practitioners from 14 community healthcare centers in Chengdu were trained by 2009 ＂Hypertension Guideline＂ of China for grass-root; each practitioner was required to manage 25 hypertensive patients during one year, based on standardized project. We evaluated the effect of non- pharmaceutical therapy before and after project and the antihypertensive effects from different therapy. Results By the end of2011, a total of 632 hypertensive patients aged from 36 to 79 with an average of 65.72± 8.55; 263 males with the mean age of （66.41±9.10） years old, 369 females with the mean age of （65.22± 8.10） years old], who were eligible for criteria with complete data had been managed for one year. The non-pharmaceutical management includes quitting smoke, limiting alcohol, limiting salt diet, reducing weight and increasing regular physical activity. At the beginning of this project, the acceptance rate of such management were 75.96%, 71.43%, 99.01%, 73.28%, and 85.00%, respectively. After one year of such non-pharmaceutical management, the proportion of patient, who suffered from smoking, alcohol drinking, excess salty diet, overweight and obesity, and lack of physical exercise, decreased from 8.54%, 5.54%, 16.00%, 55.06%, and 23.73% to 3.80%, 1.42%, 2.69%, 34.43%, and 11.39%, respectively with statistical difference （P 〈 0.001）. Overweight and obesity is the main risk factor related to lifestyle. During one year management, Systolic blood pressure decreased by 25.81, 23.71, and 27.78 mm Hg （1 mm Hg=0.133 kPa） in the patients with non-pharmaceutical therapy, pharmaceutical therapy, and both, respectively; diastolic blood pressure decreased by 10.23, 3.99, and 10.46 mm Hg, respectively, in the three groups with statistical difference （P 〈 0.05）. Conclusion Through the hypertension management, strengthening the cognition of non-pharmaceutical therapy for general practitioner can reduce both high blood pressure risk and cardiovascular risk significantly and comprehensively.