“知己健康管理”在慢性疾病患者的应用

目的:探讨"知己健康管理"模式对社区慢性疾病患者中改变不良生活方式后所产生的效果。方法:对社区57例慢性疾病患者进行3个月的强化知己健康管理,采用自身对照方法对其管理前后的生活方式、行为改变、血压及血脂等变化进行比较。结果:管理后患者血压、体重指数、腰围、血糖、血脂等均得到改善(P<0.05)。结论:"知己健康管理"可以强化社区居民对疾病的认识,改变不良的生活方式,有利于疾病的控制及危险因素水平的降低。     

克拉玛依区社区慢性病患者健康管理实践及效果研究

目的:随着人们物质生活水平的不断提高,与生活方式密切相关的慢性非传染性疾病(noninfectious chronic disease,NCD,以下简称慢性病)已成为危害人们健康的头号"公敌"。本课题立足克拉玛依市居民,通过健康管理干预方式,摸索一种更适合本地区特点的社区慢性病健康管理的方式方法,让本地区社区慢性病患者能够系统地、有效地掌握慢性病的相关知识和防控技能,建立有利于健康的生活方式,有效减少慢性病的远期并发症。方法:设立实验组和对照组。对照组采用传统的慢性病管理模式,以医院门诊、社区卫生服务中心的医务人员做一般的健康教育指导为主。实验组120人,首先建立人员的健康管理档案,进行人员的健康评估,针对每个患者的健康危险因素,制定健康管理干预措施以及健康指标的管理目标,并进行动态跟踪。6个月后统计资料,实验组与对照组进行对照分析。结果:本此实验历时6个月,通过对实验组和对照组的健康知识、生活方式、饮食结构等的健康教育干预和比较发现,健康管理干预后,试验组对慢性非传染性疾病的相关知识知晓明显优于对照组,其血压、血糖、血脂的知晓率、不良生活方式改善情况均明显好于对照组。实验组的多数患者还掌握了血压测量、指尖血糖检测、食用盐、食用油的控制,以及合理营养搭配、科学运动等。研究显示,健康管理班可让患者有效掌握健康相关知识与技能,并在实际中应用。特别是对自身疾病的认识、治疗、生活方式、饮结构改善方面,明显好于对照组。但是,对于吸烟与饮酒,两组患者在健康管理前后进行比较,没有显著性差异(p>0.05),提示短期健康管理对某些不良生活习惯影响不明显,可能需要更长时间的管理才有可能见效。结论:本研究以建立"健康管理培训班"的健康管理方式,对社区慢病患者进行系统的、有组织、有计划的健康知识与技能培训,达到了患者提升自我健康意识、管理自己健康生活方式的效果。对于克拉玛依区的社区慢病患者健康管理方式的探索,积累了一定的经验。     

城关社区老年人原发性高血压管理分析

目的探讨黎平县城关社区老年人高血压发病情况及规范化管理效果,为高血压病防治提供依据。方法选取2013年1月~2015年12月黎平县城关8个社区居住1年以上当地户籍65岁确诊为高血压患者1873例,按照公共卫生服务项目进行规范化管理,观察社区规范化管理后血压控制情况和社区管理效果结果通过规范化管理,辖区内居民高血压治疗率较管理前提高了19.86%,规范服药和主动监测血压较管理前提高了8.97%,近50%高血压病例由Ⅲ级转为Ⅱ级,Ⅱ级转为Ⅰ级,取得了良好效果。结论高血压是多因素综合引起的慢性疾病,可通过健康教育和健康促进改变不良生活方式与习惯、平衡膳食、适当运动,并依据个体化原则规范服用有效降压药物等控制高血压的发生发展。     

电话回访对社区高血压患者生活方式的影响

目的探讨电话回访式健康教育对社区高血压患者生活方式的影响。方法对在社区确诊为高血压的患者中，随机抽取200例患者，每2个月电话回访1次，进行生活方式指导、监督。1年后，观察患者现有的生活方式，并与第1个月相比较是否有所改善。结果通过电话回访后的高血压患者较回访之前在吸烟、饮酒、低盐饮食、科学锻炼、按时服药、定期测血压等生活方式方面均有明显的改善。结论在社区高血压管理中，运用电话回访式健康教育可以提高患者对疾病的认识与重视，改变不良生活方式，有效地控制病情，取得较好的效果。     

慢性非传染性疾病的预防与控制方法

目的探析慢性非传染性疾病的预防及控制方法。方法以我院在2014年1月-2015年12月抽取的500例社区居民,作为研究对象,并建立健康档案,对其均进行慢性非传染性疾病的预防干预,并提出控制方法,并选择另外500例居民没有接受慢性非传染性疾病的预防及控制方法,比较干预前后本组居民的预防结果。结果干预前,吸烟38.0%,饮酒40.4%,不良饮食习惯46.6%,慢性非传染性疾病35.0%;干预后,吸烟8.4%,饮酒8.6%,不良饮食习惯10.2%,慢性非传染性疾病13.4%;干预后本组患者在患病率及危险因素上均优于干预前,差异具有统计学意义(P0.05)。结论医务工作人员应高度重视慢性非传染性疾病的预防及控制工作,进而保证居民的健康、合理的生活,提高生活质量。     

对215例代谢综合症患者进行健康教育指导及其效果观察

目的：通过对代谢综合征（Ms）患者进行积极健康教育指导,探索促进代谢综合征患者的健康对策,减轻代谢综合征对人体的危害,提高生活质量。方法：对我科住院健康体检中确诊的215例代谢综合征患者进行健康教育指导,其中包括饮食、运动、药物应用指导、定时检测、生活方式和行为等护理干预,一年后统计分析干预前后患者危险因素,血糖、血脂、体重指数、血压等指标的变化。结果：干预后患者危险因素显著减少,空腹血糖、血甘油三脂、总胆固醇、体重指数、收缩压与舒张压等指标与干预前比较差异有统计学意义（P〈0．01）。结论：表明健康教育对延缓MS的进展及减少并发症的发生是一种有效的干预手段。     

高血压的临床诊断、预防和治疗

高血压是动脉血压持续偏高的慢性疾病.长期高血压会导致众多的并发症,如冠状动脉疾病、中风、心脏衰竭、心房颤动、周边动脉阻塞、视力模糊、慢性肾脏病及痴呆症等病症.降低血压和致命并发症的风险在于改变生活方式与药物控制,体育锻炼、降低体重、适度摄取盐分、少喝酒及均衡饮食等,这些方式都有助于高血压的控制.本研究对积极预防、正确诊断和合理治疗高血压提供了系统的知识和建议.     

浅谈高血压病的预防

高血压病是一种常见的以体循环动脉血压升高为主的综合症,是一种慢性生活方式病。可引起血管、心、脑、肾等器官的病变,是人类健康的无声杀手之一。本人结合多年的临床实践认为改变不良的生活方式,对预防和治疗高血压病是十分有效的。世界卫生组织提出健康的四大基石是合理膳食,适量运动、戒烟限酒、心理平衡、这样可使高血压减少55％,也就是说高血压这种生活方式病是可以预防的。     

98例慢性肝衰竭患者的护理体会

目的：探讨慢性肝衰竭的护理方法。方法：通过对98例慢性肝衰竭患者在抗乙型肝炎病毒、护肝和输血和白蛋白等治疗的基础上,根据疾病的不同临床表现及并发症、心理变化采取不同的个体化护理措施,同时给予患者健康教育指导。结果：治愈33例,好转28例,病情恶化自动出院17（17．34％）例,死亡20（20．40％）例。结论：根据疾病的不同临床表现、并发症采和心理改变取不同的个体护理措施,同时加强对患者的健康教育,可有助于疾病恢复及减少并发症的发生,降低患者的死亡率。     

从医联体到康联体防控慢性病策略的变化——以上海市闵行区为例

本文介绍了复旦大学附属上海市第五人民医院在不断巩固区域医疗联合体的基础上,试图建立一种以预防疾病,控制慢性疾病如慢性呼吸道感染、慢性肝病、糖尿病等,加强健康教育为目的的社区健康联合体(简称康联体)。这是一项卫生服务可持续发展的模式,其建立是基于复旦大学和闵行区的长期合作,以智慧医疗技术为依托,以"防大病、管慢病、促健康"为核心服务内容,以期及早预防社区居民严重疾病的发生,对社区慢性病患者进行方便、有效的监控,并向社区介绍先进的人口健康理念,实现全方位、全生命周期保障社区居民健康,为闵行区康联体的扩大与完善提供参考依据。希望这些方法能促进优质医疗服务的合理布局,使社区居民终身健康关怀得到发展,并在防控慢性疾病及慢性感染中发挥有效作用,在今后也能应用于其他区域。     

Social status,social context,and arterial blood pressure

As social change and economic development have proceeded, the prevalence of chronic diseases, especially cardiovascular diseases, has increased in the developing world. In part this is due to the adoption of diets and other health behaviors characteristic of industrialized nations; in part it is a function of changing social and economic circumstances. In this paper, we describe the development and testing of a model designed to account for social and economic effects on cardiovascular disease risk. The model incorporates the fact that global economic processes have made a lifestyle characterized by the consumption of Euroamerican material goods and information a basis for the assignment of social status in local communities. But economic change at the local level is rarely sufficient to provide a foundation for individuals' status aspirations. Hence, many individuals attempt to maintain a lifestyle inconsistent with their economic standing, a variable we term lifestyle incongruity. Here we describe how this factor is associated with higher blood pressure in a variety of settings and also how the effects of lifestyle incongruity can be modified in local contexts by social class and social role processes. This latter process, contextual modification, is illustrated by data from American Samoa. In this example, the association of lifestyle incongruity with blood pressure is examined in 30 male household heads and 26 spouses. After an examination of Samoan ethnography focused attention on the importance of age and gender differences as defining social contexts of intracultural variation, the model was modified to assess interactions between age and gender as they affect the association of lifestyle incongruity and blood pressure. Lifestyle incongruity is strongly associated with higher systolic and diastolic blood pressure for the younger household heads, minimally associated with blood pressure for older household heads, and only slightly associated with the blood pressure of their spouses. The regression coefficients for the lifestyle incongruity by age by sex interaction term was significant at P ≤ 0.01 for both systolic and diastolic blood pressure. The consistency of these results with expectations based on the ethnographic record is emphasized in the interpretation. We feel that the lifestyle incongruity model represents an empirically successful attempt to link global political-economic processes, local social structure, and biological outcomes. Am J Phys Anthropol 102:55–66, 1997. © 1997 Wiley-Liss, Inc.     

甲亢患者β2-微球蛋白与血脂水平相关性研究

目的：探讨甲亢患者β2-微球蛋白含量与血脂水平的相关性。方法：以甲状腺功能亢进症患者40例作为观察组,另选择同期在我院进行体检的健康人群40例为对照组,分别于治疗前和治疗后检测患者血清和尿β2-微球蛋白、血外周血载脂蛋白、血脂,并进行血清和尿β2-微球蛋白与血脂的相关性分析。结果：治疗前甲亢组血清和尿β2-微球蛋白均高于对照组（P〈0．01）;TC、TG、HDL-C、LDL-C和APOB均低于对照组（P〈0．01）;治疗后,血清和尿β2-微球蛋白与治疗前相比均有所下降（P〈0．01）,TC、TG、HDL—C、LDL-C和APOB与脂类前相比均有所升高（P〈0．01）;血清和尿β2-微球蛋白与TC、TG、HDL-C、LDL-C和APOB均呈负相关。结论：甲亢患者血清和尿β2-微球蛋白与血脂关系密切,可作为评价患者脂质代谢状态和病情变化的重要指标。     

Clinical problem solving based on the 1999 Canadian recommendations for the management of hypertension

The 1999 Canadian Recommendations for the Management of Hypertension are notable for the trends that they represent with regard to the evolution of the management of hypertension. Diagnostically, the Recommendations endorse the greater use of non-office-based measures of blood pressure control and greater emphasis on the assessment of other atherosclerotic risk factors, both when considering prognosis in hypertension and in the choice of therapy. On the treatment side of the equation, lower targets for blood pressure control have been advocated in subgroups of hypertensive patients, particularly in those with diabetes and renal disease. In conjunction with the recently published recommendations on lifestyle management, there is a greater emphasis on lifestyle modification, both as initial and adjunctive therapy in hypertension. Implicit in the recommendations for therapy is the principle that for the vast majority of hypertensive patients treated pharmacologically, practitioners should not follow a stepped-care approach. Instead, therapy should be individualized, primarily based on consideration of concurrent diseases, both cardiovascular and noncardiovascular (Tables 1 and 2). Through the consensus process, there was a general appreciation of how far we have come in the development of evidence-based recommendations for hypertension management. However, there was also an increasing appreciation of how far we have to go in effectively translating these recommendations into better blood pressure control.     

不同时间服用比索洛尔对非杓犁高衄压缸压的影响

目的：观察不同给药时间分别给予比索洛尔对非杓型原发性高血压患者的降压疗效和血压节律恢复的影响。方法：选取60例非杓型高血压患者,采取随机平行对照试验,观察比索洛尔（n=30）每日早晨（8：00）给药2．5—10mg、比索洛尔（n=30）每日夜间（20：00）给药2．5—10mg治疗8周后的降压疗效。结果：两种给药方法均能降低非杓型高血压患者的全天血压（P〈0．05）。两种给药方法在白天的血压控制上无显著性差异（P〉0．05）,但在夜间血压的控制上夜间服药降压效果具有显著性差异（P〈0．05）。夜间服药在血压节律恢复方面优于早晨服药（P〈0．05）,早晨服药组有10例恢复杓型,夜间服药组有19例恢复杓型。结论：比索洛尔的两种给药方式均能安全有效的降压,但对于非杓型高血压患者夜间服药优于早晨服药,更有利于血压节律的恢复。     

老年高血压患者健康管理的效果分析

目的：对社区老年高血压病人实行健康管理,探讨其在高血压治疗中的临床效应。方法：对老年高血压患者分为实验组和对照组。对照组未实施健康管理,实验组实施健康管理,两组治疗药物方案相同,观察降压效果。结果：统计处理,两组老年高血压病人在相同时间里的降压效果差异具有显著性,实验组血压控制较前好（P〈0．05）。结论：健康管理在老年高血压治疗中效果明显。（健康管理能减少老年高血压患者的,降低医疗经济负担）     

树脂灌血液灌流在顽固性高血压患者血液透析中的应用

目的：探讨树脂灌血液灌流对血液透析顽固性高血压患者血压及肾素-血管紧张素．醛固酮系统的影响。方法：选择我院82例,均分为I组和II组各41例,I组患者采用金宝8LR聚酰胺膜透析器进行常规透析,II组患者在常规透析的基础上串联树脂血液灌流,检测两组患者治疗前和治疗后3个月血清肌酐、尿素氮变化情况,和患者体内肾素活性、血管紧张素II和醛固酮变化情况,并对血压变化值进行比较。结果：两组患者治疗后3个月血肌酐、血尿素氮均明显较治疗前降低,I组患者治疗后3个月收缩压和舒张压较治疗前均无明显变化,II组治疗后3个月收缩压和舒张压均较治疗前明显降低,I组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前无明显差异,II组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前均明显降低。结论：血液透析联合树脂吸附灌在保证有效清除患者体内代谢物质的同时角色较好的控制患者血压。     

Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial

Background

Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care.

Methods and design

This paper describes the protocol of a nested 2 × 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months.

Discussion

Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources.

Trial registration

ClinicalTrials.gov identifier NCT00201136     

某高校教职工慢性病发病率及相关因素分析

目的：分析某高校教职工健康体检中慢性病的发病率,为早期预防和临床早期治疗提供合理依据。方法：体检对象为高校教职工,对其高血压、高血脂症、高血糖、高尿酸血症、脂肪肝和谷丙转氨酶异常的发病情况按年龄和性别分组,进行统计学分析。结果：男性发病率均明显高于女性,差异有统计学意义（P〈0.05）。高血压、高血脂症、高血糖、脂肪肝随年龄增长发病率增加,差异有统计学意义（P〈0.05）。高尿酸血症呈现低龄化。结论：慢性病的发生与性别和年龄有关,应加强高校教职工的健康教育和生活方式的指导,以提高高校教职工的身体素质和生命质量。