产后妇女高血压社区管理的需要与实施模式的可行性分析  

Needs and feasibility analysis of community management for postpartum women with hypertension

作　　者：吴玲霞 潘美巧 杨剑 Wu Lingxia;Pan Meiqiao;Yang Jian(Shanghai Xuhui Maternity and Child Care Institute,Shanghai 200235,China;Xuhui Tianping Subdistrict Community Health Service Center,Shanghai 200031,China)

机构地区：[1]上海市徐汇区妇幼保健所,上海200235 [2]上海市徐汇区天平街道社区卫生服务中心,上海200031

出　　处：《保健医学研究与实践》2023年第S02期35-40,共6页Health Medicine Research and Practice

基　　金：上海市徐汇区医学科技资助项目(SHXH202050)。

摘　　要：目的了解产后妇女高血压的患病情况和相关因素,探讨产后保健与社区高血压管理链接的可行模式。方法选取2021年6月—2022年12月上海市徐汇区分娩的3297例产妇为研究对象,选取其中产后1个月内上门访视时采用非同日3次血压测量值均收缩压≥140和(或)舒张压≥90 mmHg(1 mmHg=0.133 kPa)的产妇,或产后服用降压药且血压控制在140/90 mmHg以下的产妇,共计86例为病例组;以年龄是否超过35岁作为匹配条件,按1∶1匹配血压测量正常或未服用降压药的下一位访视产妇作为对照组。收集一般人口学特征、疾病史、孕产史、心理健康及社会支持等因素探讨产后高血压的相关因素;选取区级和社区基层妇幼保健管理者,慢性病管理者、产后访视人员、家庭医生及其他慢性病相关服务人员,以及高血压产妇共计20名,开展个人访谈,从卫生系统角度分析产后保健与社区慢病管理链接的内部优势和劣势、外部机遇和挑战。结果产后高血压的患病率为2.60%[(86/3297),95%CI=0.020~0.031],多因素条件logistic回归分析结果显示,有焦虑情绪(OR=3.619,95%CI=1.283~10.210,P=0.015)、有高血压家族史(OR=5.180,95%CI=2.514~10.673,P<0.001)和孕前BMI越高(OR=3.634,95%CI=1.280~10.621,P=0.018)的产妇发生高血压的风险增加。受访者均认为对产后高血压有必要进行长期管理,社区基层完善的妇幼保健和高血压管理工作及家医团队的参与为社区产后保健服务与社区高血压管理链接的新模式奠定了基础,其中2类服务的链接点是社区预防保健科,兼具产后保健和高血压管理职能;但产后保健服务对象的社区卫生服务签约率低、依从性不高是整合服务模式的阻力。当前,上海市慢性病健康管理支持中心的建设和重点人群签约政策的落实有利于新服务模式的实施;但社区妇幼保健与高血压管理在业务上隶属于2个不同的上级部门,且信息系统不互通�Objective To understand the prevalence and correlation factors of hypertension in postpartum women and explore feasible models for linking postpartum care with community hypertension management.Methods A total of 3,297 postpartum women who gave birth in Xuhui District,Shanghai from June 2021 to December 2022 were selected as the study participants.Among them,86 cases were included in the case group,which consisted of women who had a systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg(measured on three different days during home visits within one month postpartum)or women who were taking antihypertensive medication and had blood pressure controlled below 140/90 mmHg.The control group was matched 1:1 based on whether the age exceeded 35 years,and consisted of the next visiting postpartum women with normal blood pressure measurements or those who did not take antihypertensive medication.General demographic characteristics,medical history,obstetric history,psychological health,and social support were collected to explore the correlation factors of postpartum hypertension.Twenty personnel,including district-level and community-level maternal and child health directors,chronic disease directors,postpartum visit personnel,family doctors,and other personnel related to chronic disease services,as well as hypertensive postpartum women,were selected for individual interviews.The internal strengths and weaknesses,external opportunities and challenges of linking postpartum care with community chronic disease management were analyzed from the perspective of the healthcare system.Results The prevalence of postpartum hypertension was 2.60%(86/3297,95%CI=0.020~0.031).The results of multivariate logistic regression analysis showed that women with anxiety(OR=3.619,95%CI=1.283~10.210,P=0.015),a family history of hypertension(OR=5.180,95%CI=2.514~10.673,P<0.001),and higher pre-pregnancy BMI(OR=3.634,95%CI=1.280~10.621,P=0.018)had an increased risk of developing hypertension.The interviewees all believed that

关 键 词：产后保健 高血压管理 社区卫生服务 妊娠期高血压疾病 危险因素 

分 类 号：R714[医药卫生—妇产科学]