上海市普陀区高血压患者社区干预项目效果评价  

Efficiency of a community intervention program for hypertension outpatients in Putuo District,Shanghai

作　　者：陈科[1] 马建红[1] 吴雯静[1] 邓海巨[1] 李新建[2] 厉曙光 

机构地区：[1]上海市普陀区疾病预防控制中心慢性病科,200333 [2]上海市疾病预防控制中心心脑血管疾病科 [3]复旦大学公共卫生学院营养与食品卫生学教研室

出　　处：《上海医学》2011年第9期668-671,共4页Shanghai Medical Journal

摘　　要：目的评价上海市普陀区高血压患者社区干预项目的主要指标,为后续研究、外区平行项目、上海市总体项目提供参考与反馈。方法预设1-β=0.8,按纳入、排除标准采用多阶段整群抽样配合随机化分组形成干预组与对照组,各200例。由经培训的社区医师使用校准的工具与仪器在1年内完成3次知、信、行指标[高血压自我管理知识知晓度(KNS)]、3次物理指标、2次生化指标的采集,并进行6次基于自我效能理论的授课、讲座、互动形式的干预。结果干预组的KNS得分呈上升趋势,收缩压、舒张压、腹围呈下降趋势,且与对照组的差异均有统计学意义(P值均<0.01)。干预组KNS干预前后的差值为(1.98±4.96)分,显著高于对照组的(0.22±6.53)分(P<0.01)。干预组收缩压、舒张压干预前后的差值为(3.96±11.73)和(2.71±7.17)mmHg(1mmHg=0.133kPa),显著高于对照组的(0.49±10.56)和(0.44±5.98)mmHg(P值均<0.01)。干预组干预后的腹围为(84.8±10.6)cm,较干预前的(91.3±11.3)cm显著下降(P<0.01);对照组的差异则无统计学意义(P>0.05)。舒张压改变与腹围变化有关联(β=0.132,P<0.05)。结论干预对血压与腹围的下降有贡献,而腹围下降对舒张压下降有贡献。KNS的提高可能是干预效应的中间环节。Objective To evaluate the main items of a community intervention program for hypertension outpatients in Putuo District, Shanghai, in order to obtain references and feedbacks for parallel projects for other districts and the main project of Shanghai. Methods Prospective Power was set to 0.8. According to I/O rules, trial and control groups were formed with 200 patients on each side by a multistage cluster sampling method with randomized grouping. Fully trained community medicate personals were responsible for a total of 3 times of the items from knowledge, attitude, practice and skills （KAPS）, 3 times physical examinations, 2 times biochemical tests, 6 times self-efficacy based interventions via pre-adjusted tools and apparatus. Results Score of knowledge networks survey （KNS） had a rising tendency in trial group; but systolic pressure （SBP）, diastolic pressure （DBP）, and circumference of abdominal circumference （ABC） had a decreasing tendency in the group, showing significant differences compared with those of control group （P〈0.01）. AKNS was significantly higher in trial group （[ 1.98 ±4. 961 scores） than in the control group （0.22 ± 6.53 scores） （ P〈0. 01 ）. ASBP and ADBP were significantly higher in trial group （[-3.96 ±11. 731, [-2.71 ± 7. 171 mmHg） than in control group （[-0.49 ±10. 561, [-0.44 ±5.98]. mmHg, P〈0. 01 ）. ABC in trial group was lower after intervention （[84.8 ±10.6 cm） than before （[-91.3± 11.31 cm, P〈0. 01 ）. ABC in control group showed no difference through time （P〉0.05）. ADBP was significantly related to AABC （β = 0. 132, P〈0.05）. Conclusion Intervention contributes to the decrease of blood pressure and ABC, while ABC can alter DBP. The improvement of KNS might be a way of how intervention works. （Shanghai Med J, 2011, 34： 668-671）

关 键 词：高血压 社区 干预 评价 重复测量 

分 类 号：R544.1[医药卫生—心血管疾病]