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[30034例高血压患者中西医诊治医学模式的真实世界研究]

[Study on medical pattern of traditional Chinese medicine and western medicine diagnosis and treatment of hypertension patients in 30 034 cases in real world].

作者信息

Ma Jin-hui, Wang Zhi-fei, Xie Yan-ming, Yang Wei, Yang Zhi-xin, Zhuang Yan, Wang Yong-yan

出版信息

Zhongguo Zhong Yao Za Zhi. 2014 Sep;39(18):3435-41.

Abstract

Select patients diagnosed of hypertension in the first place in 16 hospitals and the patients were described by association rules analysis and distribution for the analysis in the study,in order to understand the information of diagnosis and treatment in hypertension patients in real world. The information include age, gender, admission condition, inpatient department, hospitalization expenses, western medicine comorbidities, the traditional Chinese medicine (TCM) syndrome and the medicine. The average age of patients was 64 years in the study. The proportion of men to women about 1. 10: 1. Admission condition is critical for about 10.12% of the total and more concentrated in the cardiovascular department. Hospital stay ranged from 8 to 14 d. Inpatients with medical insurance is 62.93%. Total hospitalization cost distribution most is the 5 000-10 000 RMB. Hypertension complicated with coronary heart disease, blood lipoprotein disorder disease; phlegm and blood stasis and Yin deficiency of liver and kidney are the most in TCM syndrome type. Promoting blood circulation and removing blood stasis is the major in Chinese medicine treatment. Western medicine treatment basically conforms to the guidelines. The most antihypertensive drugs is calcium antagonistst, accounting for about 81.2% of the total number. Class ACEI, class ARB, beta blockers, diuretics class are accounted for 43.0%, 43.4%, 42.4%, 42.4%, fixed compound is only 2 393, accounting for about 8%. the total frequency of five classes of antihypertensive drugs is 78 206 times. The principal conclusions of this analysis are as follows: the elderly people is the most in hypertension, more men than women; medical insurance is the majority type in hospitalization cost; nearly half of the population is combined with coronary heart disease; phlegm and blood stasis and yin deficiency of liver and kidney are the most in TCM syndrome type; western medicine treatment basically conforms to the guidelines. Combination therapy is more, less fixed compound preparation in western medicine. Chinese medicine is mainly to promoting blood circulation. Suggesting that the clinical treatment in strict blood pressure and at the same time, pay attention to combination therapy and the use of fixed compound preparation,it's useful to control the blood pressure better. Combined with traditional Chinese medicine and resolving phlegm and removing blood stasis, reduce the target organ damage, reduce complications, the prevention and control work of hypertension in China still faces enormous challenges at present. The result provides reference information for clinical medicine and medical research.

摘要

选取16家医院首诊诊断为高血压的患者,采用关联规则分析和分布描述的方法对患者进行研究分析,以了解真实世界中高血压患者的诊疗信息。信息包括年龄、性别、入院情况、住院科室、住院费用、西药合并症、中医证型及用药情况。研究中患者的平均年龄为64岁,男女比例约为1.10:1。入院情况危急的约占总数的10.12%,且多集中于心血管科。住院天数为8至14天。有医保的住院患者占62.93%。住院总费用分布最多的是5000 - 10000元。高血压合并冠心病、血脂异常症;痰瘀互结证和肝肾阴虚证是中医证型中最多的。中医治疗以活血化瘀为主。西医治疗基本符合指南。最常用的降压药物是钙拮抗剂,约占总数的81.2%。ACEI类、ARB类、β受体阻滞剂、利尿剂类分别占43.0%、43.4%、42.4%、42.4%,固定复方制剂仅2393例,约占8%。五类降压药物总频次为78206次。本次分析的主要结论如下:高血压患者中老年人居多,男性多于女性;住院费用类型以医保为主;近半数人群合并冠心病;中医证型中痰瘀互结证和肝肾阴虚证最多;西医治疗基本符合指南。西药联合治疗较多,固定复方制剂较少。中医主要以活血化瘀为主。提示临床治疗在严格控制血压的同时,注意联合治疗及固定复方制剂的使用,有助于更好地控制血压。结合中医化痰祛瘀,减少靶器官损害,降低并发症,我国高血压的防治工作目前仍面临巨大挑战。研究结果为临床医学及医学研究提供参考信息。

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