高血压患者群组干预管理的社区实施与评价

目的 评价群组干预管理对社区高血压患者的干预效果,探索高血压管理新模式.方法 2011年1月始在本社区卫生服务中心采用随机对照研究,将400例符合条件的高血压患者随机分为干预组和对照组,每组患者200例.干预组接受高血压群组干预管理,对照组接受常规的高血压三级管理.干预时间为6个月,采用自我效能（症状效能、疾病效能、体锻效能）评价、社会支持、应对技能、健康状况（健康自评、精力、情绪低落、健康担忧）等指标以及血压、血脂、腰臀比、体重指数等生物学指标来评价干预效果.结果 干预前两组的人口学指标差异无统计意义,干预后干预组在自我效能、健康状况的变化值明显优于对照组,其中症状效能、疾病效能和体锻效能分别比对照组多增加了0.54分、0.52分和1.30分（P＜0.05）.健康自评、情绪低落和健康担忧分别比对照组多下降0.41分、1.76分和0.17分（均P＜0.05）.干预组的收缩压、舒张压比对照组分别多下降了5 mmHg（1 mmHg=0.133 kPa ）和2 mmHg,低密度脂蛋白较对照组多下降0.24 mmol/L;而体重指数、腰臀比等变化比较差异无统计学意义（均P＞0.05）.结论 社区高血压群组干预管理模式较常规的三级管理模式能明显改善高血压患者的自我效能、健康状况及血压水平.

Evaluation of hypertension group-interference-management model in the community

Objective To evaluate the effeetlveness of hypertension group-lntervention-management model in the eonmmnity. Methods Four hundred hypertensive patients in the eomumnity were randomly assigned into intervention group and control group （n = 200 in eaeh） in January 2011. Patients in intervention group reeeived group-interventlon management tbr 6 months, those in eontrol group received routine management serviee. Self-efficaey, Community-support, Coping skill, Health status and Blood pressure eontrol （ineluding blood fat, waist-to-hip ratio, body mass index） seales were adapted to evaluate the effectiveness of intervention. Results There were no significant differenees in demography index between 2 groups. Patients in intervention group showed greater improvement in Self-efficacy （SE to manage symptom, disease and exercise）, Health status （health self-evaluation, energy, low spirit and heahh distress） scores compared to eontrol group （ all P 〈 0.05 ）. The score increasing of SE to manage symptom, disease and exercise in intervention group was 0. 54, 0.52, and 1.30 more than that in control group（ all P 〈0. 05 ）. The score decreasing of Health Self-evaluatlon, low spirit, and health distress in intervention group was 0. 41 , 1.76 and 0. 17 more than that in eontml group（ all P 〈 0. 05 ）. The decreasing of systolic blood pressure, diastolie blood pressure anti blood low density lipoprotein in intervention group was 5 mmHg （ 1 mmHg = 0. 133 kPa） and 2 mmtfg and 0. 24 mmol/L more than in control group, respectively （ all P 〈0.05）. There were no significant differences in body mass index, waist-to-hip ratio between two groups （P 〉 0. 05）. Conclusion The community-based group-interferenee model is more effective than the routine management service lbr management of hypertensive patients in the comnmnity.