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中文摘要: 目的 观察区域医疗联合体双向转诊联合社区健康管理对原发性高血压控制率的影响。方法 将所有符合纳入标准的患者随机分为干预组和对照组，分别予以双向转诊联合社区健康管理和门诊常规降压治疗，观察两组治疗前后的血压控制率。结果 干预组与对照组比较，高血压1级患者的日间即时血压、心电图ST-T改变、高低密度脂蛋白和内生肌酐清除率以及高血压2级患者的日间即时血压舒张压、总胆固醇和高血压3级患者的日间即时及24小时动态舒张压、总胆固醇和甘油三酯等方面均有统计学差异（P＜0.05）。干预组、对照组日间即时血压、24小时动态血压达标率分别为73.33%、53.33%和63.33%、45.00%，两组比较有统计学差异（P＜0.05）。结论 医联体双向转诊联合社区健康管理是保证高血压治疗效果的有效模式，值得推广。
Abstract:Objective To observe the effect of two way referral combined with community health management on the control rate of essential hypertension. Methods All patients who met the inclusion criteria were randomly divided into intervention group and control group. They were given bidirectional referral combined with community health management and routine antihypertensive treatment. The blood pressure control rate of the two groups before and after treatment was observed.Results Between the intervention group and the control group，there were significant differences in daytime blood pressure, ECG ST-T changes, high and low density lipoprotein, and endogenous creatinine clearance in patients with grade 1 hypertension，in daytime blood pressure、cholesterol in patients with grade 2 hypertension and immediate and 24 hour ambulatory diastolic blood pressure,cholesterol and triglyceride in the patients with grade 3 hypertension (P＜0.05).The compliance rates of immediate blood pressure and ambulatory blood pressure were 73.33%, 53.33% and 63.33%, 45% respectively in the intervention group and the control group. There was significant difference between the two groups (P＜0.05). Conclusion Two-way referral combined with community health management is an effective mode to ensure the curative effect of hypertension, and it is worth popularizing.
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