规范管理高血压患者对24 h动态血压监测的接受情况及其影响因素研究

doi:10.12114/j.issn.1007-9572.2019.00.133

摘要/Abstract

摘要： 背景　动态血压监测能够反映一天中血压的波动，对高血压的诊断、治疗、预后和研究具有重要意义。但还未在广大居民中普及。目的　明确对24 h动态血压监测接受情况的影响因素，为24 h动态血压监测在规范管理高血压患者中的推广提供建议。方法　于2018年6—7月，调取上海市金山工业区社区卫生服务中心过去1年中接受过24 h动态血压监测的在管高血压患者169例，对其进行历史资料调取和问卷调查。同期，采用方便抽样法，按1∶1的比例选择不接受24 h动态血压监测的在管高血压患者169例。调查两组患者对高血压相关知识了解情况、高血压的相关行为危险因素、目前临床表现及相关治疗手段、对24 h动态血压监测的态度。采用Logistic回归分析患者是否接受24 h动态血压监测的影响因素。结果　169例接受24 h动态血压监测的患者表示，24 h动态血压监测不太方便携带和操作、对其是否有利于自身血压控制也不太赞同，也并不十分愿意继续佩戴仪器进行血压监测。169例不接受24 h动态血压监测的患者表示，不接受24 h动态血压监测的最主要原因是不方便〔58.6%（99/169）〕、血压正常无需佩戴〔30.2%（51/169）〕及没时间〔25.4%（43/169）〕。患者对高血压诊断标准、高血压治疗方法及治疗方案考虑因素的了解情况、祖父/外祖父有无高血压病史、精神紧张频率、有无进行体质量控制及高血压相关症状是高血压患者对24 h动态血压监测是否接受的主要影响因素（P<0.05）。结论　可从患者对高血压知识的了解、日常行为习惯、临床表现和治疗等影响因素方面对患者进行动态血压监测宣教普及，以及从简化动态血压监测操作等方面进行24 h动态血压监测推广的改进。

关键词: 血压测定；血压监测, 便携式；病人接受卫生保健的程度；影响因素分析

Abstract: Background　24-hour ambulatory blood pressure monitoring（ABPM） can reflect the fluctuation of blood pressure during the day，which is of great significance for the diagnosis，treatment，prognosis and research of hypertension.However，it is still not widely used in residents.Objective　To examine the acceptance and associated factors of 24-hour ABPM in hypertensive patients，providing recommendations for the promotion of 24-hour ABPM in patients with standardized hypertension management.Methods　This study was conducted from June to July 2018.Participants were hypertensive patients receiving management services from Jinshan Industrial Park Community Health Center selected by convenience sampling，including 169 who received 24-hour ABPM service in the past year，and 169 hypertensive patients did not.Historical data were collected.And a questionnaire survey was used to obtain both groups' knowledge about hypertension，behavioral risk factors for hypertension，current clinical manifestations and related treatments，and attitudes toward 24-hour ABPM.Logistic regression was used to determine the factors associated with the acceptance of 24-hour ABPM.Results　Patients receiving 24-hour ABPM reported that 24-hour ABPM devices were not convenient to carry and operate，and they were not sure whether such monitoring was beneficial to blood pressure control，and they were less willing to continue to undergo 24-hour ABPM.Those not receiving 24-hour ABPM service reported that they did not receive this service mainly due to inconvenience〔58.6%（99/169）〕，having no need of such service because of owning normal blood pressure〔30.2%（51/169）〕，or having no time〔25.4%（43/169）〕.Patients' understanding of diagnostic criteria，treatment methods and treatment options for hypertension，grandfather/grandfather history of hypertension，frequency of mental stress，whether or not to carry out body mass control，and hypertension-related symptoms were associated with the acceptance of 24-hour ABPM.Conclusion　Recommended facilitation strategies are as follows：providing patient education about 24-hour ABPM from perspectives of hypertensive knowledge，daily behavioral habits associated with hypertension，clinical manifestations and treatment of hypertension，and simplifying the operating procedure of 24-hour ABPM devices.

Key words: Blood pressure detemination；Blood pressure monitoring, ambulatory；Patient acceptance of health care；Root cause analysis

杨旦红,刘锐,顾丽钰,等. 规范管理高血压患者对24 h动态血压监测的接受情况及其影响因素研究[J]. 中国全科医学, 2019, 22(19): 2345-2350. DOI: 10.12114/j.issn.1007-9572.2019.00.133.
YANG Danhong,LIU Rui,GU Liyu, et al. Acceptance and Associated Factors of 24-hour Ambulatory Blood Pressure Monitoring in Patients with Standardized Hypertension Management　[J]. Chinese General Practice, 2019, 22(19): 2345-2350. DOI: 10.12114/j.issn.1007-9572.2019.00.133.

参考文献

［1］卢永萍，潘颖，王曼．24小时动态血压监测的临床应用及评价［J］．医学理论与实践，2011，24（3）：275-277．DOI：10.3969/j.issn.1001-7585.2011.03.013.
LU Y P，PAN Y，WANG M．Clinical application and evaluation of 24-hour ambulatory blood pressure monitoring［J］．The Journal of Medical Theory and Practice，2011，24（3）：275-277．DOI：10.3969/j.issn.1001-7585.2011.03.013.
［2］刘彦君．糖尿病下肢动脉病变的干细胞治疗［J］．中国医学前沿杂志，2011，3（3）：50-52．DOI：10.3969/j.issn.1674-7372.2011.03.011.
LIU Y J．Stem cell therapy for diabetic lower extremity arterial disease［J］．Chinese Journal of the Frontiers of Medical Science，2011，3（3）：50-52．DOI：10.3969/j.issn.1674-7372.2011.03.011.
［3］郭屹．关于提升基层医疗机构服务能力的对策与建议［J］．中国经贸，2016，21（15）：77．DOI：10.3969/j.issn.1009-9972.2016.15.047.
GUO Y．Countermeasures and suggestions on improving the service ability of primary medical institutions［J］．China Business Update，2016，21（15）：77．DOI：10.3969/j.issn.1009-9972.2016.15.047.
［4］曹滢.动态动脉硬化指数与原发性高血压患者血压昼夜节律的相关性研究［J］．实用心脑肺血管病杂志，2017，25（6）：14-18.DOI：10.3969/j.issn.1008-5971.2017.06.004.
CAO Y.Correlation between ambulatory arterial stiffness index and circadian rhythm of blood pressure in patients with essential hypertension［J］．Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2017，25（6）：14-18.DOI：10.3969/j.issn.1008-5971.2017.06.004.
［5］包安华．基层高血压的诊断及治疗亟需推广24小时动态血压监测［J］．中外健康文摘，2011，8（29）：5-6．DOI：10.3969/j.issn.1672-5085.2011.29.001.
BAO A H．Diagnosis and treatment of primary hypertension is urgently needed to promote 24-hour ambulatory blood pressure monitoring［J］．World Health Digest，2011，8（29）：5-6．DOI：10.3969/j.issn.1672-5085.2011.29.001.
［6］黄玲，蒋晓芳．动态血压监测的护理体会［J］．中国中医药现代远程教育，2011，9（2）：146．DOI：10.3969/j.issn.1672-2779.2011.02.114.
HUANG L，JIANG X F．Nursing experience of ambulatory blood pressure monitoring［J］．Chinese Medicine Modern Distance Education of China，2011，9（2）：146．DOI：10.3969/j.issn.1672-2779.2011.02.114.
［7］宋秀玲，王晔．高血压的预防与控制［J］．华南预防医学，2015，41（3）：287-290.
SONG X L，WANG Y．Prevention and control of hypertension［J］．South China Journal of Preventive Medicine，2015，41（3）：287-290.
［8］李格．史载祥中西医结合治疗高血压的临床思路和经验［J］．中西医结合心脑血管病杂志，2006，4（3）：235-237．DOI：10.3969/j.issn.1672-1349.2006.03.021.
LI G．Clinic thought way and experience on hypertensive treatment with integrating of Chinese and western medicine by Shi Zaixiang［J］．Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease，2006，4（3）：235-237．DOI：10.3969/j.issn.1672-1349.2006.03.021.
［9］杨娉婷，陈志恒，朱小玲，等．高血压病的分级健康管理［J］．中华健康管理学杂志，2008，2（5）：304-305．DOI：10.3760/cma.j.issn.1674-0815.2008.05.018.
YANG P T，CHEN Z H，ZHU X L，et al．Graded health management of hypertension［J］．Chinese Journal of Health Management，2008，2（5）：304-305．DOI：10.3760/cma.j.issn.1674-0815.2008.05.018.
［10］陶祥，张晋萍，张荣林，等．动态血压监测评价依那普利治疗轻中度高血压的疗效［J］．医药导报，2010，29（1）：42-44．DOI：10.3870/yydb.2010.01.014.
TAO X，ZHANG J P，ZHANG R L，et al．Evaluation of the efficacy of Enalapril in the treatment of mild to moderate hypertension by ambulatory blood pressure monitoring［J］．Herald of Medicine，2010，29（1）：42-44．DOI：10.3870/yydb.2010.01.014.