安庆农村高血压患者生活质量及其影响因素的研究

1、安庆农村高血压患者生活质量及其影响因素的研究 目录英文缩写及中英文对照 中文摘要 7 英文摘要10 1引言. 15 2对象和方法. 16 2.1研究对象16 2.2 研究方法17 2.3 质量控制19 3 结果与分析. 20 3.1 一般情况20 3.2 生活质量评分. 23 3.3 各可能影响因素与生活质量总分的关系 33 4 讨论. 35 4.1 高血压患者的生活质量水平. 36 4.2 各因素与生活质量的关系 37 4.3 高血压患者及其生活质量影响因素小结 41 5 结论. 41 5.1 讨论 41 5.2 研究缺乏41 5.3 研究优点41 5.4 对策及建议 42 参考文献43 附

2、件 45 附录 53 致谢 54综述 55 英文缩写及中英文对照英文缩写 英文全称 中文名 BMI body mass index 体质指数 SBP systolic blood pressure 收缩压 DBP diastolic blood pressure 舒张压 SF-36 the MOS 36 item short form health survey 简明健康状况调查表 CVD Cardiovascular disease 心血管疾病 WHO World Health Organizatin 世界卫生组织 ASH The American Society of Hypertensi

3、on 美国高血压协会 QOL quality of life 生活质量 RP role physical生理职能 PF physical functioning生理功能 BP bodily pain躯体疼痛 GH general health总体健康 social functioning SF 社会功能 vitality VT 活力 role emotional RE 情感职能 mental health MH 精神健康 health transition HT 健康变化1安庆农村高血压患者生活质量及其影响因素研究中文摘要目的:了解农村中老年高血压患者的生活质量,探讨有关影响因素。方法:采用多

4、阶段整群随机抽样的方法,先抽取安庆市望江和枞阳两县,每县再抽取 6-7 个乡镇,对每个镇所有行政村年龄在 45 周岁及以上的常住人口(居住该地 5年以上)进行高血压筛查。高血压诊断标准为平均收缩压SBP 140mmHg 和/或舒张压DBP 90mmHg,或/和调查时血压正常,但过去诊断为高血压并且调查时正在服降压药者。由经过培训的调查人员对患者进行血压、体重及身高测量,并采用简明健康状况调查表SF-36及自编的根本情况问卷对1 673名原发性高血压患者的生命质量进行研究。资料采用描述性统计分析、卡方检验、单因素和多因素逐步线性回归。结果:一,高血压患者的生活质量各维度都比健康对照组差。 二,

5、(1)男性在 PF、RP、GH、SF、RE、MH各维度得分显著高于女性 ,而在 BP、VT维度的得分低于女性。 (2)?65岁组在 PF和 SF 维度均高于 65岁组。 (3)有伴侣组在 PF、RP、SF、RE 维度高于无伴侣组,而在 GH、VT维度低于后者。(4)文化程度不同的几组患者在 PF、RP、VT、BP、GH、RE、MH 因子上得分有显著差异 ,在 SF 维度上无差异。运用区间比拟法得出在 PF 得分:文盲组得分低于小学组、初中组、高中组;RP 得分:小学组低于高中组;BP 得分:文盲比小学组、初中组、高中、大专及以上高;VT 得分:文盲比大专及以上低;GH 得分:文盲比小学组、初中

6、组、高中、大专及以上低;RE 得分:文盲比小学组、初中组、高中、大专及以上低;MH得分:文盲比小学组、初中组、高中、大专及以上低。 (5)个人月收入生活质量评分在 PF、RP、BP、GH、RE维度上显示差异有统计学意义在 VT、SF、MH 维度上无差异。运用区间比拟法得出在 PF 得分:500 元组低于 501-1000 元及 1000元以上组; RP得分:500 元组低于 501-1000 2 元及 1000 元以上组;BP 得分:500 元组低于 501-1000 元及 1000 元以上组;GH得分:500 元组低于 501-1000 元及 1000元以上组;RE得分:500 元组低于 5

7、01-1000元组。 (6)自费组生活质量得分在 RE、RP、PF维度比非自费组低,在 BP维度比非自费组高,在 VT、MH、SF、MH维度无差异。 (7)各级高血压之间的生活质量得分在 VT、MH维度差异有显著意义,在其他维度差异无统计学意义。运用区间比拟法得出在 VT得分:3级高血压组低于 1级高血压组;MH维度:3 级高血压组低于 1 级高血压组和 2 级高血压组。(8)体质指数 PF、RP、BP、GH、RE 维度得分有显著差异,在其他维度差异无统计学意义。运用区间比拟法得出在 PF 得分:消瘦组得分低于正常组、超重组和肥胖组;RP 得分:消瘦组得分低于正常组和超重组;BP 得分:消瘦组

8、得分低于肥胖组;GH 得分:消瘦组得分低于正常组、超重组和肥胖组;RE得分:消瘦组得分低于正常组、超重组和肥胖组。(9)病程除了在 GH 维度3 年组显著低于3 年组,其他各维度均无显著差异。(10)体育锻炼的因子分比拟除了运动组在 SF 维度显著低于不运动组,其他各维度差异无统计学意义。(11)吸烟各组在 PF、RP、BP、GH 维度有显著差异,其他各维度差异无统计学意义。PF 得分:10 支组得分低于10 支组;RP得分:10 支组得分高于10 支组;BP 得分:10 支组得分低于10 支组;GH得分:10 支组得分低于10 支组。(12)饮酒各组在 PF、RP、BP、GH、SF 维度有显

9、著差异,其他各维度差异无统计学意义。 运用区间比拟法得出在 PF 得分: 2两组得分比不喝酒高,比2两组低;RP得分:2两组得分比不喝酒高,比2 两组低;BP 得分:不饮酒组比2 两组和2 两组高;GH 得分:2 两组得分比不喝酒高,比2 两组低;SF 得分:不饮酒组低于2 两组。(13)精神状况各组患者在 PF、GH、VT、RE、MH 五个维度的得分焦虑组显著低于不焦虑组,RP维度的因子得分与不焦虑组没有显著差异,BP、SF维度的因子得分显著高于不焦虑组。(14)有无其他慢病患者在 PF、RP、BP、GH、RE 维度有显著差异,在 VT、SF、MH维度无差异。有其他慢病患者在 PF、RP、G

10、H、RE维度得分低于无慢病者,在 BP 维度那么相反。(15)疾病重视程度的因子分比拟患者在 PF、RP、BP、GH、VT、RE维度有显著差异,在 SF、MH维度无差异。运用区间比拟法得出在PF、RP、GH、RE 维度上的得分都是很重视组得分低于一般重视组和不重视组,3 在 VT 和 RE 得分上很重视组得分低于一般重视组,而在 BP 维度上很重视组得分高于一般重视组和不重视组。 (16)睡眠情况患者各维度在 PF、RP、BP、GH、RE、MH 维度差异有显著性,在 VT 和 SF 维度无差异。运用区间比拟法得出在 PF 和RP 得分上睡眠质量一般的要高于睡眠质量不好的,在 BP 得分上睡眠质

11、量好的要高于睡眠质量一般和不好的组别,在 GH 得分上,睡眠质量一般的高于睡眠质量好的,在 RE得分上睡眠质量一般的要高于睡眠质量不好的,在 MH得分上睡眠质量一般的高于睡眠质量好的。 (17)单因素方差分析显示:性别、收入水平、精神状况、文化程度、运动情况、婚姻状况、睡眠情况、合并其他慢病 、医保情况、对高血压重视程度, 对高血压患者生活质量总分产生影响。(18)多元线性逐步回归分析发现,性别,收入水平,文化水平,婚姻状况,精神状况,患有其他慢性疾病,体育锻炼,医保情况是影响高血压患者生活质量的重要因素。结论:本次研究结果显示,高血压患者的生活质量普遍比健康对照组差。年龄、睡眠情况、吸烟情况

12、、饮酒情况、体质指数、病程和血压分级在生活质量的多维度评价时呈现出显著性差异,但在总分比拟时未见明显差异,很可能是患者生活质量的影响因素。性别、收入水平、文化水平、婚姻状况、精神状况、患有其他慢性疾病、体育锻炼、医保情况和对疾病态度是影响高血压患者生活质量的决定因素。关键词:农村;高血压;SF-36;生活质量4 Study on Quality of Life and Related Impact Factors of Patients with Hypertension in Anqing Rural AreaAbstract Objectives: To investigate quali

13、ty of life in middle and old aged hypertensive patients in Anqing countryside of Anhui and to discuss its determinants Methods: A survey was made among the people of Anqing region, using the multistage random cluster sampling. Firstly, the county of Wangjiang and Zongyang were selectedSecondly, six

14、or seven towns of each city were selected. Thirdly, permanent residentsliving more than 5 years of each incorporated village of the towns,aged 45 and over,were screened for hypertension .Hypertension was defined as mean systolic blood pressure?or?140mmHg, diastolic blood pressure?or?90mmHg, and /or

15、use of antihypertensive medications. The measurements of blood pressure, weight and height were obtained by trained observers. And questionnaire cited on SF-36 instrument and determinants of QOL and basic state quetionnaire were used to make surveys on1673hypertensive patients. The individuals who p

16、articipated the questionnaire survey were randomly selected. The obtained data were analyzed by descriptive statistics, Chi-square test, single and multivariate linear stepwise regression analysis Results: 1 Every domain of hypertensive patients were significantly lower than those in the health subj

17、ects group.2(1) The scores of PF,RP,GH,SF,RE,MH domain were lower in female patients than in male patients,and The scores of BP、VT domain were lower in male patients than in female patients.(2)The scores of PF and SF domain were significantly higher in patients at the age of below 65 than those abov

18、e 65.(3)The scores of PF,RP,SF,RE domain were significantly higher in patients at the age of who 5 have companion than those whom have not.However, The scores of GH,VT domain were significantly lower in patients at the age of who have companion than those whom have not.4 There were significant diffe

19、rence inPF,RP,VT,BP,GH,RE,MH dimensional subscales in educational level in patients.Analysis indicated that the score of PF domain was lower in illiterate group than in primary school group,ang high school group, the score of RP domain was lower in primary school group than in high school group, the

20、 score of BP domain was higher in illiterate group than in primary school group、in high school group and above college or university group; the score of VT domain was lower in illiterate group than above college or university group, the score of GH domain was lower in illiterate group than in primar

21、y school group in high school group and above college or university group; the score of RE domain was lower in illiterate group than in primary school group in high school group and above college or university group; the score of MH domain was lower in illiterate group than in primary school group i

22、n high school group and above college or university group. there was no significant difference in SF dimensional scores.5 There was significant difference in PF,RP,BP,GH,RE dimensional subscales at aspect of month income of patients. Analysis indicated that the score of PF domain was significantly l

23、ower in 500 yuan group than in 501-1000yuan group and above 1000 yuan group ; the score of RP domain was significantly lower in 500 yuan group than in 501-1000yuan group and above 1000 yuan group ; the score of BP domain was significantly lower in 500 yuan group than in 501-1000 yuan group and above

24、 1000 yuan group; the score of GH domain was significantly lower in 500 yuan group than in 501-1000 yuan group and above 1000 yuan group; the score of RE domain was significantly lower in 500 yuan group than in 501-1000 yuan group. there was no significant difference in VT、SF、MH dimensional scores.6

25、 The scores of RE,RP and PF domain was higher in half at public expense/ at public expense group than in all at one's own expenses group. The scores of BP domain was lower in half at public expense/ at public expense group than in all at one's own expenses group. there was no significant dif

26、ference in VT,MH,SF,MH dimensional 6 scores.7 The scores of VTdomain was higher in1 group than in3 group. he scores of MH domain was higher in mild hypertension group than in moderate hypertension group and severe hypertension group. there was no significant difference in other dimensional scores.8

27、There were significant difference in PF,RP,BP,GH,RE dimensional subscales in BMI level in patients. Analysis indicated that the score of PF domain was significantly lower in angular group than in The normal group, super overweight and obese group ,the score of RP domain was significantly lower in an

28、gular group than in The normal group and obese group , the score of BP domain was significantly lower in angular group than obese group, the score of GH domain was significantly lower in angular group than in The normal group, super overweight and obese group , the score of RE domain was significant

29、ly lower in angular group than in The normal group, super overweight and obese group. there was no significant difference in other dimensional scores.9 There were significant difference in GH dimensional subscales in course of disease in patients.the score of GH domain was significantly lower in 3 y

30、ear group than in 3 year group, there was no significant difference in other dimensional scores.(10)The score of SF domain was significantly lower in exercisegroup than in don't exercise group, there was no significant difference in other dimensional scores.(11)There were significant difference

31、in PF,RP,BP,GH dimensional subscales in smoking level in patients, The score of PF domain was significantly lower in 10 cigarettes than in 10cigarettes group, The score of RP domain was significantly higher in10 cigarettes than in 10cigarettes group, The score of BP domain was significantly lower in

32、10 cigarettes than in 10cigarettes group, The score of GH domain was significantly lower in10 cigarettes than in 10cigarettes group. there was no significant difference in other dimensional scores. 12 There were significant difference in PF,RP,BP,GH,SF dimensional subscales in drinking level in pati

33、ents, The score of PF domain was significantly higher in 2 wine than in 2 wine group and not drink group, The score of RP domain was significantly higher in 2 wine than in 2 wine group and not drink group, The score 7 of BP domain was significantly lower in not drink group,than in 2 wine group and 2

34、 wine group, The score of GH domain was significantly lower in 2 wine group than in2 wine group and not drink group. The score of SF domain was significantly lower in not drink group than in2 wine groupthere was no significant difference in other dimensional scores.13 The scores of PF,GH,VT,RE,MH do

35、main was higher in not anxious group than in feel anxious group. The scores of BP,SF domain was lower in not anxious group than in feel anxious group. there was no significant difference in RP dimensional scores.( 14)There were significant difference in PF,RP,BP,GH,RE dimensional subscales in with o

36、r without other chronic disease in patients, The scores of PF,RP,GH,RE domain was lower in with other chronic disease group than in f without other chronic disease group. The scores of BP domain was higher in with other chronic disease group than in without other chronic disease group. there was no

37、significant difference in RP dimensional scores.15 There were significant difference in PF,RP,BP,GH,VT,RE dimensional subscales in disease attention in patients, The scores of PF,RP,GH,RE domain was lower in seriously attention group than in general attention and not value group. The scores of VT an

38、d RE domain was lower in general attention than in seriously attention group, there was no significant difference in SF and MH dimensional scores.16 There were significant difference in PF,RP,BP,GH,RE,MH dimensional subscales in sleeping in patients, there was no significant difference in SF and VT

39、dimensional scores. The scores of PF and RP domain was lower in sleeping well group than in general sleeping group. The scores of BP domain was higher in sleeping well group than in general sleeping and sleeping worse group, The scores of GH domain was higher in general sleeping group than in sleepi

40、ng well group. The scores of RE domain was higher in general sleeping group than in sleeping worse group. The scores of MH domain was higher in general sleeping group than in sleeping well group.17 Single factor analysis of variance show that age, morpheus condition, the smoking, drinking, Body mass

41、 indexBMI, course of disease and blood pressure grading show significant difference in evaluate of multi-dimensional show significant difference , But 8 total life quality of patients were not seen in more obvious difference.The were likely the factors influencing the quality of life of the patients

42、18 Multivariate linear stepwise regression analysis indicated that Gender, income, cultural level,mental status, with or without other chronic diseases, physical exercise, payment of medical expenses, attitude to disease are important factors affecting the quality of life Conclusions: The results sh

43、ow that the life quality of patients with hypertension were worsened than healthy controls. Age, morpheus condition, the smoking, drinking, Body mass indexBMI, course of disease and blood pressure grading show significant difference in evaluation of multi-dimensional show significant difference , Bu

44、t total life quality of patients were not seen in more obvious difference.The were likely the factors influencing the quality of life of the patients.Gender, income, cultural level,mental status, with or without other chronic diseases, physical exercise, payment of medical expenses, attitude to dise

45、ase are important factors affecting the quality of lifeKey words: countryside/ hypertension/ SF ? 36/ Quality of life 9 安庆农村高血压患者生活质量及其影响因素研究1 引言 高血压是严重危害老年人健康的常见疾病 , 能引起多种代谢紊乱 ,是脑卒1亿 ,而老年人高血压的发病率占高血压病人的 60%70% ,无论兴旺国家还是发2展中国家,高血压都很普遍。Wolf-Maier K 等 调查研究发现北美洲国家(美国和加拿大)35 岁以上人群高血压的患病率为 28%,而欧洲国家(德国、瑞

46、士、英国、西班牙、意大利等)35 岁以上人群的患病率为 44%。而在我国,高血压的患3病率也在较高水平并有升高趋势。1991 年全国血压抽样调查 结果显示我国高血4压患病率为11.88%,2002年中国居民营养与健康调查显示 ,我国 18 岁以上人群高血压患病率为18.8%。大量研究说明,血压升高是心脑血管发病的独立危险因5-8素 ,而心脑血管疾病已经成为中国人的首位死因。因此,有效的降低血压,对降低心血管疾病的发病率和死亡率,防止脑卒中、冠心病、心力衰竭和肾病的发生和开展具有极其重要的意义。随着医学模式发生了从生物医学模式转向生物-心理-社会医学模式的转变,“医学目的也相应的发生了改变 ,预

47、防疾病和损伤、促进和维持健康、解除病9痛 , 对有病的照料和治愈、防止早死和追求安详死亡等应成为“医学目的 。在新的医学模式下去评估慢性病如高血压的防治效果,仅仅用发病率、病死率、治愈率、期望寿命等参数难以做到全面和准确。而生命质量 quality of life, QOL 作为专门的综合评价术语逐渐受到重视。WHO 定义生命质量为个体在一定文化与价值观下 ,对其所处地位及状况的感受。它与个人的目标、期望标准和所关心的事物有关。它是一个范围很广的概念 ,是包括机体健康、心理状态、独立生活水平、社会关系、个人信念及与明显的环境特征有关的内容的集合体。生命质量(QOL)更注重个体主观感觉, 是适应

48、医学模式转变的新的代表性健康指标。生活质量评价自诞生之日起,就被广泛的应用10 于人群综合健康状况的评定、慢性病测评、探讨健康影响因素及防治重点、卫生资源配置与利用的决策等方面。高血压作为长病程的慢性终身性疾病 ,给患者的身心健康带来极大的危害,严重地影响了患者的生命质量。国内外有研究说明 ,高血压患者的生命质量相比10-12健康人群有所下降 ;高血压患者的总体健康、生理功能、生理职能、躯体疼13痛、活力、情感职能、精神健康等均明显低于健康对照 。针对影响高血压患者生命质量的因素,国内外学者也做了研究。Mena -Martin 等研究分析了是否知晓自己患有高血压对生命质量的影响 ,结果提示 ,

49、知晓自己患有高血压病的患者较未知晓的患者生命质量更低 ,这可能与标答效应和14或者 药物治疗副反响有关 。 Klocek 等对健康人和高血压患者的生命质量进行调查研究后发现,原发性高血压患者的生命质量显著低于血压正常人,性别、教育程度和年龄均为独立影响生命质量的因素 ,而在高血压人群中,除了这三个影响因素,家族史、收缩压、舒张压、肥胖、合并靶器官损害和用药的数量也都对患15,16者的生命质量形成影响 。2 对象和方法2.1 研究对象 本项研究调查安庆市望江县和枞阳县的农村常住人口(居住该地 5年以上),年龄 45 周岁及以上原发性高血压患者,血压符合平均收缩压SBP 140mmHg g和/或舒

50、张压DBP 90mmHg,或/和调查时血压正常,但过去诊断为高血压并且调查时正在服降压药者。本次调查由安徽医科大学生物研究所安庆分所组织,通过乡镇卫生院、村两委发动群众,村医、村干部配合调查员入户调查。在组织发动时,要求村干准备好各村民组 45-75 岁人员名单,根据各村组人员名单,进行高血压筛查。 2.1.1 入选标准 1)年龄:45周岁及以上的男女病人; 11 2)I、级原发性高血压患者; 3)自愿参加并签署知情同意书;2.1.2 排除标准 1)既往发生过诊断明确的脑卒中者; 2既往发生过诊断明确的心肌梗死、心力衰竭者; 3严重躯体系统性疾病,无法完成调查者; 4确诊的继发性高血压; 5严

51、重精神障碍,无法表达意愿者; 6不愿参加本试验调查者;2.2 研究方法 2.2.1 文献研究法 通过国内外学术期刊网、卫生部及世界卫生组织、美国高血压协会(ASH)等相关网站收集关于高血压防治现状、生命质量评价等方面的文献。2.2.2 现场调查法 采用多阶段随机整群抽样的方法,先抽取安庆市望江县和枞阳县两县,每县再抽取 6-7 个乡镇,对每个镇所有行政村中年龄在 45 周岁及以上的常住人口(居住该地 5 年以上)进行高血压筛查(血压符合平均收缩压SBP 140mmHg 和/或舒张压DBP 90mmHg,或/和调查时血压正常,但过去诊断为高血压并且调查时正在服降压药者),由调查人员对患者进行血压

52、、体重及身高测量,并随机抽取部分患者进行问卷调查。 (1)血压测量 血压测量一律采用校正后的台式水银血压计和听诊器,采用坐位姿势,测量时对象的右上臂与心脏置于同一水平。测量当天要求测量对象先在房间内静坐,35分钟后开始测量。人均测量至少两次,间隔12 分钟,假设两次测量结果相差比12 较大(差值4mmHg),或者早晨吸烟、饮酒者,都要求休息20分钟后再测量。17高血压诊断标准依据?中国高血压防治指南(2005年修订版)? 的规定,测量对象在未服抗高血压药物的情况下,血压的均值SBP 140mmHg(18.6Kpa)和/或DBP 90mmHg12Kpa,或者调查时血压正常,但过去诊断为高血压并且正在服用抗高血压药物者均被确定为入选者。 (2)身高、体重测量 身高、体重按标准方法测量,测量身高时要求被调查者摘去帽子,站在标尺前,脚跟并拢,两臂自然下垂,肩部、臀部及脚跟贴墙,精确读数至 0.1cm。体重用台秤测量,要求被查者脱去外衣及鞋子,精确度为 0.1kg。按照 WHO 对亚洲人2 2的体重指数标准建议,体重指数