江苏省淮安市社区高血压患者利尿剂使用情况及影响因素的混合研究  

A mixed study on the use of diuretics and influencing factors in hypertensive patients in communities of Huai̓an City,Jiangsu Province

作　　者：谢舒 陈丹翔 汪丽 张艳艳 李雪琴[1] XIE Shu;CHEN Danxiang;WANG Li;ZHANG Yanyan;LI Xueqin(Department of General Practice,The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院全科医学科,江苏淮安223300

出　　处：《中华高血压杂志(中英文)》2024年第12期1141-1148,共8页Chinese Journal of Hypertension

基　　金：淮安市自然科学生命健康专项软课题(2023KX0007)。

摘　　要：目的分析江苏省淮安市社区高血压患者利尿剂使用情况及影响因素。方法采用横断面研究方法,2022年6至12月,选取淮安市4094例社区高血压患者作为研究对象,对患者利尿剂使用情况以及相关的临床资料进行统计分析。同期选取社区和综合医院的全科医生作为访谈对象,访谈内容主要包括门诊降压药的处方原则,处方利尿剂的原则以及对于利尿剂在高血压治疗方案中的评价和建议,采用主题框架分析法对访谈结果进行分析。结果高血压患者4094例中415例使用利尿剂,利尿剂使用率为10.14%。高血压患者使用的利尿剂均为长效制剂,其中使用单片制剂的患者有162例(39.04%),低于使用复方制剂的253例(60.96%)。使用占比排名前三的药物分别为厄贝沙坦氢氯噻嗪(35.18%)、吲达帕胺(31.81%)、复方阿米洛利(8.67%)。使用利尿剂者受教育程度、签约家庭医生比例、伴有合并症比例、高密度脂蛋白胆固醇(HDL-C)水平低于未使用利尿剂者,高血压病程、独居比例、高血压2级比例、静息心率、空腹血糖、服药前舒张压、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、血肌酐水平高于未使用利尿剂者。使用利尿剂者的血压控制率(37.83%)相对高于未使用利尿剂者(30.14%)。多因素logistic回归分析结果显示,受教育程度较低(OR=1.292,95%CI 1.042~1.602)、签约家庭医生(OR=0.656,95%CI 0.518~0.830)、独居(OR=1.367,95%CI 1.067~1.752)、有合并症(OR=0.786,95%CI 0.621~0.994)、服药前舒张压较高(OR=1.017,95%CI 1.002~1.032)、甘油三酯较高(OR=1.114,95%CI 1.045~1.187)、LDL-C较高(OR=1.165,95%CI 1.046~1.298)为影响利尿剂使用的相关因素(均P<0.05)。本研究共访谈了20名全科医生,提炼出3个主题:①大部分全科医生认为利尿剂疗效好;②对于高血压患者,一般不首选或是单用利尿剂;③降压药可选种类较多、利尿剂副作用明显及价格上并没有明显优势等是导致�Objective To analyze the use of diuretics and its influencing factors in hypertensive patients in communities of Huai̓an City,Jiangsu Province,China.Methods Using a cross-sectional study method,4094 hypertensive patients in Huai'an City were enrolled from June to December 2022.The usage of diuretics and clinical data of patients were analyzed.General practitioners(GPs)from communities and general hospitals were selected as interviewees during the same period.The contents of the interview mainly included the principles of antihypertensive drug prescription in the outpatient department,the principles of diuretic prescription,and the evaluation and suggestions of diuretics in the treatment of hypertensive patients.The results of the interview were analyzed by the topic framework analysis method.Results Among 4094 patients,415 cases(10.14%)were using diuretics.The diuretics used by hypertensive patients were all long-acting preparations,with 162 patients(39.04%)using single tablets,which was lower than 253 patients(60.96%)using single-pill combination.The top three drugs used in terms of proportion were irbesartan hydrochlorothiazide(35.18%),indapamide(31.81%)and compound amiloride hydrochloride(8.67%).The educational level,proportion of contracted family doctors services and complication,the level of high density lipoprotein cholesterol(HDL-C)of patients who used diuretics were lower than those who did not use diuretics,and the course of hypertension,the proportion of living alone and grade 2 hypertension,the level of rest heart rate,fasting blood glucose,diastolic blood pressure,triglcyerid,low density lipoprotein cholesterol(LDL-C),serum creatinine were higher than those who did not use diuretics(all P<0.05).The blood pressure control rate in patients using diuretic(37.83%)was higher than that in those not using diuretics(30.14%).Furthermore,the results of multivariate logistic regression analysis indicated that low educational level(OR=1.292,95%CI 1.042-1.602),contracted family doctors services(OR=0.656,95%CI 0.

关 键 词：利尿剂 高血压 影响因素 血压控制率 

分 类 号：R544.1[医药卫生—心血管疾病]