中老年妇女高血压社区规范化管理模式和效果

目的 分析中老年妇女高血压社区规范化项目管理模式及其效果，为完善社区卫生服务体系提供基层资料。方法 选择45～63岁在本中心辖区确诊为高血压病（288人）及高危者（101人）为研究对象，实施有关高血压的知识、态度和行为等基线调查，据2010中国高血压防治指南，建立健康档案，实行分级管理，随访包括血压测量、健康教育和治疗方案调整，在基线调查的基础上，实施为期2年的社区规范管理。结果 实施规范管理后，中老年高血压高危妇女在高血压知识、态度和行为方面的正确率均有显著性改善（χ^2分别为5．298、5．592、4．457，均P＜0．05），高血压患者对高血压知识、态度和行为的正确率也均有显著性改善（χ^2分别为7．871、6．970、6．856，均P＜0．01），高危妇女收缩压显著降低（t＝4．619，P＜0．01），舒张压也显著降低（t＝2．220，P＜0．05），高血压患者收缩压和舒张压均显著降低者t值分别为23．598、11．884，均P＜0．01。经过1年的规范管理，与心血管健康相关的一些生化指标也获得了改变，与规范管理前比较，高血压妇女的总胆固醇、三酰甘油、低密度脂蛋白均显著降低（t值分别为2．679、2．281、3．288，均P＜0．05），且高危妇女的总胆固醇、三酰甘油水平均显著下降（t值分别为2．039、1．981，均P＜0．05）。规范管理后患者治疗率、血压控制的优良率和控制率均有改善（χ^2分别为159．625、16．359、21．387，均P＜0．05），而不良率却显著下降（χ^2＝5．641，P＜0．05）。结论 社区规范管理有助于改善高血压患者的治疗和控制。

Mode and effect of community-based standard management on middle-aged and aged women with hypertension

Objective To analyze the mode and effect of community-based standard management on middle-aged and aged women with hypertension in order to provide basic data for the improvement of community health service system .Methods A total of 389 cases, including 288 cases with hypertension and 101 high risk persons from Yonghe Community Health Service Center aged 45-63 years old, were investigated with self-designed questionnaires on knowledge , attitude and practice （ KAP） about hypertension .According to 2010 Chinese Guidelines of Hypertension Prevention and Control , health archives were established and the graded management was performed .Follow-up management involved blood pressure reading ,health education and treatment adjustment .On the basis of baseline investigation , community standard management was carried for one year .Results After standard management the correct rate of KAP of hypertension among high risk middle-aged and aged women was significantly increased （χ^2value was 5.298, 5.592 and 4.457, respectively, all P〈0.05）, and that among women with hypertension was also significantly increased after standard management （χ^2value was 7.871, 6.970 and 6.856, respectively, all P〈0.01）.The systolic pressure of high risk women was significantly decreased （t=4.619, P〈0.01）, and the diastolic pressure was also significantly decreased （t=2.220, P〈0.05）.The systolic pressure and diastolic pressure of women with hypertension were significantly decreased （t value was 23.598 and 11.884, respectively, both P〈0.01）.After one-year standard management , the total cholesterol, triacylglycerol and low density lipoprotein of women with hypertension were significantly decreased （t value was 2.679, 2.281 and 3.288, respectively, all P〈0.05）, and the total cholesterol and triacylglycerol of high risk women were also significantly decreased （t value was 2.039 and 1.981, respectively, both P〈0.05）.The curative rate, good rate of blood pressure control and control rate were signific