摘要
目的 评价在职业人群中开展高血压综合干预对高血压患者生活质量的改善效果.方法 整群随机对照试验研究.采用整群抽样方法,2012-2015年在全国15个省份选择20个医疗机构作为分中心,每个分中心选择条件可匹配的2～4家职业场所,随机分成管理组(40家)和常规组(20家).管理组实施职业场所心血管病一级预防及高血压患者规范化管理的综合干预策略,每位患者至少管理2年;常规组采用职业场所现行的管理方案,收集基线及2年后的资料.对最终入选的4 248例高血压患者(管理组3 254例和常规组994例)进行资料分析.主要观察指标为高血压生活质量问卷(MINICHAL)得分,干预效果为管理组随访前后的差值(均值)-常规组随访前后的差值(均值).采用多元线性回归模型进行影响MINICHAL得分的多因素分析.结果 多元线性回归分析结果显示,性别、文化程度、医疗资源配置、经济水平、吸烟、饮酒、运动、高血压病程和压力/紧张/易怒是职业场所高血压患者生活质量的主要影响因素(均为P＜0.05).实施综合干预措施后,管理组患者MINICHAL总得分、精神维度得分和身体维度得分均优于常规组(均为P＜0.01).箱式图显示,管理组患者基线、12个月和24个月时MINICHAL总得分、精神维度得分和身体维度得分的差异均有统计学意义(均为P＜0.001).经过干预后,基线收缩压高水平职工的MINICHAL总得分(β=-3.1 × 10-2)、精神维度得分(β=-1.0×10-2)和身体维度得分(β=-1.7×10-2)更低(均为P＜0.05);血压得到控制的职工相较于未控制的职工MINICHAL总得分(β=1.0)、精神维度得分(β=-0.3)和身体维度得分(β=-0.5)更低(均为P＜0.01).结论 在职业场所开展高血压综合干预可改善高血压患者的生活质量,干预后血压得到控制的职工生活质量更好.
Abstract
Objective To evaluate the effect of a comprehensive hypertension intervention on the quality of life improvement for hypertensive patients in occupational sites.Methods This study was a cluster randomized controlled trial.Using the cluster sampling method,20 medical institutions were selected as sub-centers across 15 provinces in China.Each sub-center selected two to four occupational sites with matchable conditions,which were randomly assigned into a management group(40)and a general group(20).The management group implemented a comprehensive intervention strategy for primary prevention of cardiovascular disease in occupational sites and standardized management of hypertensive patients,with each patient managed for at least 2 years.The general group used the management program currently in occupational sites and collected information at baseline and 2 years later.Data from 4 248 hypertensive patients(3 254 in the management group and 994 in the general group)were analyzed.The primary outcome was the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial(MINICHAL)score.The intervention effect was the difference before and after follow-up in the management group(mean)and the difference before and after follow-up in the general group(mean).Multiple linear regression models were used for multifactorial analysis of the MINICHAL score effects.Results The multiple linear regression analysis suggested that gender,literacy,medical resource allocation,economic level,smoking,alcohol consumption,exercise,duration of hypertension,and stress/tension/irritability were the main factors affecting the quality of life of hypertensive patients in occupational settings(all P＜0.05).Following the implementation of comprehensive interventions,patients in the management group showed better MINICHAL total scores,mental dimension scores,and physical dimension scores than those in the general group(all P＜0.01).Box plots showed statistically significant differences in MINICHAL total scores,mental dimension scores,and physical dimension scores at baseline,12 months,and 24 months in the management group(all P＜0.001).Post-intervention,workers with high baseline systolic blood pressure had lower MINICHAL total scores(β=-3.1×10-2),mental dimension scores(β=-1.0×10-2),and physical dimension scores(β=-1.7×10-2)(all P＜0.05);Compared to uncontrolled workers,workers whose blood pressure was controlled had lower MINICHAL total scores(β=-1.0),mental dimension scores(β=-0.3),and physical dimension scores(β=-0.5)(all P＜0.01).Conclusions Comprehensive hypertension intervention in occupational sites can improve the quality of life for hypertensive patients.Workers whose blood pressure is controlled following the intervention has a better quality of life.
基金项目
国家科技支撑计划(十二五)(2011BAI11B01)
NETL
NSTL
万方数据