药学强化干预社区高血压患者的效果及预测卒中发病风险

doi:10.3760/cma.j.issn.1007-1245.2024.03.014

摘要/Abstract

摘要：

目的　探讨药学强化干预社区高血压患者的效果及预测10年卒中发病风险情况。方法　选取2021年10月至2022年7月于郑州市东大街社区卫生服务中心就诊的180例高血压患者进行随机对照试验，采用随机数字表法分为对照组与干预组。对照组90例，女39例，男51例，年龄（63.17±4.27）岁，给予常规临床干预；干预组90例，女41例，男49例，年龄年龄（63.49±4.05）岁，在对照组基础上给予药学强化干预。比较两组患者干预前后血压［收缩压、舒张压］、血糖［空腹血糖、糖化血红蛋白］、血脂［三酰甘油、总胆固醇、低密度脂蛋白］水平，采用改良弗明汉卒中量表预测两组10年卒中发病风险，采用抑郁-焦虑-压力量表中文简版（DASS-21）、医学应对方式问卷（MCMQ）、自我护理能力量表（ESCA）、Morisky服药依从性量表（MMAS-8）进行评价，统计学方法采用χ²检验、t检验、秩和检验。结果　干预后，干预组收缩压、舒张压均低于对照组［（118.63±7.15）mmHg（1 mmHg=0.133 kPa）比（130.56±10.53）mmHg、（80.71±8.25）mmHg比（93.11±9.34）mmHg，差异均有统计学意义（t=8.892、9.440，均P<0.001）；干预组空腹血糖、三酰甘油、糖化血红蛋白、总胆固醇、低密度脂蛋白均低于对照组［（5.23±0.65）mmol/L比（5.79±0.74）mmol/L、（1.38±0.14）mmol/L比（1.51±0.16）mmol/L、（5.72±0.56）%比（6.18±0.69）%、（4.80±0.34）mmol/L比（5.11±0.41）mmol/L、（2.37±0.34）mmol/L比（2.69±0.41）mmol/L］，差异均有统计学意义（t=5.394、5.801、4.911、5.521、5.700，均P<0.001）；干预后，干预组10年卒中发病风险低于对照组［低危：38.89%（35/90）比23.33%（21/90），中危：44.44%（40/90）比45.56%（41/90），高危：16.67%（15/90）比31.11%（28/90）］差异有统计学意义（Z=2.523，P=0.008）；干预组DASS-21评分低于对照组［（16.13±3.04）分比（23.23±6.07）分］（t=9.922，P<0.001），MCMQ、ESCA评分、MMAS-8评分高于对照组［（70.11±9.09）分比（58.34±8.95）分、（102.05±21.01）分比（75.14±15.19）分、（14.25±4.24）分比（11.12±3.20）分，差异均有统计学意义（t=8.753、9.847、5.590，均P<0.001）。结论　药学强化干预社区高血压患者，可改善患者血压，调节血脂和血糖，降低10年卒中发病风险，缓解焦虑情绪，提升自我管理能力、治疗积极性及用药依从性。

关键词:

高血压, 社区, 药学强化干预, 10年卒中发病风险, 焦虑情绪, 自我管理能力, 用药依从性

Abstract:

Objective　To investigate the effect of pharmaceutical intensive intervention for community hypertensive patients and to predict the risk of ischemic stroke in 10 years. Methods　A total of 180 patients with hypertension treated at Community Health Service Center of Dongdajie, Zhengzhou from October 2021 to July 2022 were selected for the randomized controlled trial, and were divided into a control group and an intervention group by the random number table method, with 90 cases in each group. There were 39 females and 51 males in the control group; they were (63.17±4.27) years old. There were 41 females and 49 males in the intervention group; they were (63.49±4.05) years old. The control group took routine clinical intervention; in addition, the intervention group took pharmaceutical intensive intervention. The systolic and diastolic blood pressures and levels of fasting blood glucose, glycated hemoglobin, total triglyceride, total cholesterol, and low density lipoprotein before and after the intervention were compared between the two groups. The Modified Flamingham Stroke Scale was used to predict the 10-year stroke risk of the two groups. The Chinese version of Depression-Anxiety-Stress Scale (DASS-21), Medical Coping Style Questionnaire (MCMQ), Self-care Ability Scale (ESCA), and Morisky Medication Compliance Scale (MMAS-8) were used to evaluate all the patients. χ² test, t test and rank sum test were used. Results　After the intervention, the systolic and diastolic blood pressures in the intervention group were lower than those in the control group [(118.63±7.15) mmHg (1 mmHg=0.133 kPa) vs. (130.56±10.53) mmHg and (80.71±8.25) mmHg vs. (93.11±9.34) mmHg], with statistical differences (t=8.892 and 9.440; both P<0.001). The levels of fasting blood glucose, total triglyceride, glycated hemoglobin, total cholesterol, and low density lipoprotein in the intervention group were lower than those in the control group [(5.23±0.65) mmol/L vs. (5.79±0.74) mmol/L, (1.38±0.14) mmol/L vs. (1.51±0.16) mmol/L, (5.72±0.56)% vs. (6.18±0.69)%, (4.80±0.34) mmol/L vs. (5.11±0.41) mmol/L, and (2.37±0.34) mmol/L vs. (2.69±0.41) mmol/L], with statistical differences (t=5.394, 5.801, 4.911, 5.521, and 5.700; all P<0.001). After the intervention, the 10-year risk of stroke in the intervention group was lower than that in the control group [low risk: 38.89% (35/90) vs. 23.33% (21/90); middle risk: 44.44% (40/90) vs. 45.56% (41/90); high risk: 16.67% (15/90) vs. 31.11% (28/90)], with a statistical difference (Z=2.523, P<0.001). The score of DASS-21 in the intervention group was lower than that in the control group [(16.13±3.04) vs. (23.23±6.07); t=9.922; P<0.001]. The scores of MCMQ, ESCA, and MMAS-8 in the intervention group were higher than those in the control group [(70.11±9.09) vs. (58.34±8.95), (102.05±21.01) vs. (75.14±15.19), and (14.25±4.24) vs. (11.12±3.20)], with statistical differences (t=8.753, 9.847, and 5.590; all P<0.001). Conclusion　Pharmaceutical intensive intervention for community hypertensive patients can improve their blood pressures, regulate their blood lipids and blood glucose, reduce the risk of stroke in 10 years, relieve their anxiety, and increase their self-management ability, treatment enthusiasm, and medication compliance.

Key words:

Hypertension, Community, Pharmaceutical intensive intervention, Risk of stroke in 10 years, Anxiety, Self-management ability, , Medication compliance

翟留群郑滑李瑜付海尔李蒙赵媛媛王陆巡任梦媛.

药学强化干预社区高血压患者的效果及预测卒中发病风险 [J]. 国际医药卫生导报, 2024, 30(3): 419-424.

Zhai Liuqun, Zheng Hua, Li Yu, Fu Hai'er, Li Meng, Zhao Yuanyuan, Wang Luxun, Ren Mengyuan.

Effect of pharmaceutical intensive intervention for community hypertensive patients and prevention of ischemic stroke [J]. International Medicine and Health Guidance News, 2024, 30(3): 419-424.

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