利用24h尿钠检测结果和血压测量对社区高血压患者进行减盐教育的探索-现代医学

利用24h尿钠检测结果和血压测量对社区高血压患者进行减盐教育的探索

单位：1. 江苏省南通卫生高等职业技术学校, 江苏南通 226000;
2. 南通市学田社区卫生服务中心, 江苏南通 226000;
3. 南通市竹行社区卫生服务中心, 江苏南通 226000

分类号：R544.1

出版年·卷·期（页码）：2022·50·第一期（115-120）

摘要：

目的： 利用24 h尿钠检测结果和血压测量对社区高血压患者开展减盐教育，比较患者盐摄入量的变化及对血压的影响，以探索有效方式帮助患者降低盐摄入量，提高患者对血压的管控能力，为社区高血压患者的有效规范化管理探寻新思路。方法：选取2020年7~8月本市4个社区医院就诊的血压控制情况不理想的高血压患者100例，采用24 h尿钠法评估患者日平均盐摄入量，同时测量患者血压值，将患者按初次尿钠检测评估的盐摄入量多少分为高盐摄入组，盐摄入量≥10 g·d^-1；中盐摄入组，盐摄入量6～10 g·d^-1；低盐摄入组，盐摄入量≤6 g·d^-1。利用检测与测量结果对病人进行减盐教育，2个月后再次评估患者日平均盐摄入量并测量患者血压值。结果：利用初次检测与测量结果开展减盐教育后再次检测时患者的日平均盐摄入量和血压值较初次结果均有所下降，降幅分别为2.46 g·d^-1和4.80/2.04 mmHg，差异均有统计学意义。再次检测时高盐摄入量患者例数有显著减少而中等盐摄入量患者例数有所增多，差异有统计学意义。初次检测时的高盐摄入组、中盐摄入组患者后经再次检测其盐摄入量有明显降低(下降幅度分别为3.50、1.49 g·d^-1),收缩压平均值也均有明显下降(下降幅度分别为6.79、2.86 mmHg)，差异有统计学意义。高盐摄入组患者的盐摄入量、收缩压下降幅度均大于初次检测的中盐摄入组患者。高盐摄入组患者再次检测时舒张压也有明显下降，降幅2.73 mmHg。低盐摄入组患者后来的盐摄入量变化、血压变化均不明显。患者盐摄入量变化与血压变化均呈正相关(相关系数r值分别为0.734、0.605；均P<0.001)。结论：运用24 h尿钠法评估高血压患者盐摄入量并以此开展减盐教育能够有效降低患者均盐摄入量，帮助患者提高对血压的管理效果。

Objective: To carry out salt reduction education by the results of 24-hour urine sodium test and blood pressure measurement for patients with hypertension in the community, and the changes of salt intake and its impact on blood pressure were compared, so as to explore effective ways to help patients reduce salt intake, improve the ability of patients to control blood pressure, and explore new ideas for effective standardized management of patients with hypertension in the community. Methods: A total of 100 hypertensive patients with poor blood pressure control in 4 community hospitals in the city from July to August 2020 were selected. The average daily salt intake of the patients was evaluated using 24-hour urine sodium method, and the blood pressure of the patients was measured. The patients were divided into high salt intake group(salt intake≥10 g·d^-1), medium salt intake group(salt intake 6~10 g·d^-1) and low salt intake group(salt intake 6~10 g·d^-1) The salt intake was less than or equal to 6 g·d^-1. Two months later, the average daily salt intake of the patients was evaluated again, and the blood pressure of the patients was measured. Results: The daily average salt intake and blood pressure(systolic/diastolic blood pressure) decreased by 2.46 g·d^-1 and 4.80/2.04 mmHg respectively. The number of patients with high salt intake(≥10 g·d^-1) decreased significantly, while the number of patients with medium salt intake(6 ~ 10 g·d^-1) increased, the difference was statistically significant. After the first test, the salt intake of patients in the high salt intake group and patients with medium salt intake group decreased significantly(the decline ranges were 3.50 g·d^-1 and 1.49 g·d^-1 respectively) and the average systolic blood pressure decreased significantly(the decline ranges were 6.79 mmHg and 2.86 mmHg respectively). The difference was statistically significant. The decrease of salt intake and systolic blood pressure in the high salt intake group were greater than those in the medium salt intake group. In the high salt intake group, the diastolic blood pressure also decreased significantly by 2.73 mmHg. The changes of salt intake and blood pressure were not significant in the low salt intake group. The changes of salt intake were positively correlated with the changes of blood pressure(systolic/diastolic blood pressure)(the correlation coefficient r values were 0.734 and 0.605 respectively; P values were less than 0.001). Conclusion: Using 24-hour urine sodium method to evaluate salt intake of hypertensive patients and carrying out salt reduction education can effectively help patients reduce salt intake and improve the effect of blood pressure management.

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