健康管理对慢性肾脏病患者血压控制的影响  

The effect of health management on hypertension control in outpatients with chronic kidney diseases

作　　者：朱勍[1] 张东亮[1] 崔文英[1] 刘文虎[1] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科首都医科大学肾病学系,北京100050

出　　处：《临床和实验医学杂志》2013年第9期691-693,共3页Journal of Clinical and Experimental Medicine

基　　金：北京市科学技术委员会计划项目(D09050704310903);首都临床特色应用研究项目(Z121107001012138);首都卫生发展科研专项(首发2011-2002-02);北京市自然科学基金资助项目(7132091)

摘　　要：目的观察慢性肾脏病(CKD)专科门诊实施健康管理对于CKD 3～4期合并高血压患者血压控制情况的影响。方法对265例在CKD门诊规律随访的CKD 3～4期合并高血压患者进行前瞻性的健康管理,随访12个月,对比健康管理前后患者血压控制情况,包括:疾病知晓率、血压达标率等,评估健康管理的实际效果。应用Logestic回归分析血压达标的相关因素。结果患者接受CKD专科门诊健康管理后,对高血压知晓率由89.4%增至97.7%,血压控制靶值(收缩压<130 mmHg且舒张压<80 mmHg)知晓率由55.8%增至83.0%药物治疗率由88.3%增至92.8%,血压达标的比率由18.9%增至39.2%,P均<0.05。在接受健康管理的患者中,有利于血压达标的因素包括:高中以上教育程度(OR=0.54,P=0.030)、知道血压靶值(OR=0.25,P=0.003)、在家自测血压(OR=0.53,P=0.042)、及应用血管紧张素转换酶抑制剂或血管紧张素II受体抑制剂(OR=0.35,P=0.001)。结论对CKD门诊随访患者开展健康管理可以有效提高血压控制达标率。Objective To observe the effect of health management proceeded by chronic kidney disease （CKD） clinic on hypertension control in patients with chronic kidney diseases （CKD） in 3rd and 4th stages. Methods There were 265 adult patients with CKD in 3rd and 4th stages with hypertension in the CKD clinic of Beijing Friendship Hospital. They were treated by prospective health management and followed up for 12 months. A standard questionnaire had been adopted, and blood pressure （BP） was measured by trained staffs. The percentage of awareness on knowledge of hypertension and BP was compared between baseline and follow - up for 12 months. The related factors of BP were analyzed by Logistic regression. Results The percentage of awareness both on hypertension （ from 89.4% to 97.7% ） and targeted BP （ from 55.8 % to 83.0% ） in these patients had been significantly raised （ P 〈 0. 05 ） and the percentage of medicine treatment was increased from 88.3% to 92.8% （ P 〈 0. 05 ）. The percentage of targeted BP in all patients increased from 18.9 % to 39.2% （ P 〈 0. 05 ）. The related factors on BP control included the application of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers （ OR = 0.35, P = 0. 001 ）, degree of education （ OR =0.54, P =0.030）, awareness of targeted BP （OR =0.25, P =0.003）, and self-measuring BP at home （OR=0.53, P =0.042）. Conclusion The control of BP in CKD patients with hypertension can be improved by health management.

关 键 词：慢性肾脏病 高血压 门诊 前瞻性研究 健康管理 

分 类 号：R692[医药卫生—泌尿科学]