智能化健康教育模型对高血压合并慢性肾脏病患者的管理效果

Management effect of an intelligent health education model in patients with hypertension and chronic kidney disease

摘要

目的 探讨智能化健康教育模型对高血压合并慢性肾脏病（CKD）患者的管理效果。方法 2021年1月至2023年1月采用“分组隐藏+统计人员盲态”的盲法方案，入选武汉市第四医院诊断为高血压合并CKD的患者680例。将患者分为常规组和智能化组，每组340例。常规组采用常规健康教育，智能化组为智能化健康教育模型组，使用My结构化查询语言MySQL数据库存储和训练数据以及超文本预处理器编写脚本调用智能算法进行数据分析、模型建设和开发，构建智能化健康教育管理模型。每组干预6个月，比较干预前后两组患者的肾功能、血压、血脂、生活质量、疾病应对能力、疾病知晓率的差异，以及干预后干预完成度、血压达标率、满意度和药物依从性的改善情况。采用logistic逐步回归法分析影响高血压合并CKD患者血压达标的影响因素。结果 干预6个月,常规组失访3例,智能化组失访1例,以完成全程干预及随访的患纳入分析。两组干预完成度差异无统计学意义[88.5%比89.1%，χ²=0.330，P=0.565）；智能化组血压达标率[293例(86.4%)比247例(73.2%)，χ²=18.510，P＜0.001]；满意度评分（27.43±1.45比22.97±1.30，t=42.229，P＜0.001）、服药依从性评分（6.76±0.33比5.22±1.04，t=18.403，P＜0.001）均高于常规组。与干预前比较，两组干预后估算的肾小球滤过率（eGFR）和高密度脂蛋白胆固醇（HDL-C）、社会功能、生理功能、躯体疼痛、生理职能、精力、一般健康状况、精神健康、情感职能评分，面对评分、疾病知晓率均升高（均P＜0.05）；血肌酐、尿素氮、尿酸、血压、24 h白蛋白排泄率、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）、屈服和回避评分降低（均P＜0.05）。与常规组比较，智能化组改善更明显（均P＞0.05）。logistic回归分析结果显示，智能化组（OR=0.351，95%CI：0.220～0.558，P＜0.001）、两药联用（OR=0.487，95%CI：0.323～0.735，P=0.001）、三药联用（OR=0.286，95%CI：0.164～0.497，P＜0.001）、四药联用（OR=0.216，95%CI：0.080～0.589，P=0.003）及运动1～2次/周（OR=0.599，95%CI：0.388～0.926，P=0.021）及运动≥3次/周（OR=0.375，95%CI：0.219～0.645，P＜0.001）是高血压合并CKD患者血压达标的保护因素。结论 智能化模型管理方案能改善高血压合并CKD的治疗效果，是血压达标的保护因素。

Abstract

Objective To investigate the management effect of an intelligent health education model in patients with hypertension and chronic kidney disease (CKD). Methods From January 2021 to January 2023, a total of 680 patients diagnosed with hypertension and CKD at Wuhan Fourth Hospital were enrolled using a blinding scheme of “concealed allocation + blinded statistician”. Patients were randomly divided into a routine group and an intelligent group, with 340 cases in each group. The routine group received conventional health education, while the intelligent group was managed with an intelligent health education model. MySQL database was used for data storage and training, and PHP was applied to script intelligent algorithms for data analysis, model construction, and development. All patients received 6 months of intervention. Renal function, blood pressure, blood lipid, quality of life, disease coping ability, and disease awareness rate were compared before and after intervention between the two groups. Intervention completion rate, blood pressure control rate, satisfaction, and medication compliance after intervention were also evaluated. Multivariate stepwise logistic regression was used to analyze factors influencing blood pressure control in patients with hypertension and CKD. Results After 6 months of intervention, 3 patients in the routine group and 1 patient in the intelligent group were lost to follow-up; only patients whocompleted the ful intervention and follow-up were included in the analysis. There was no significant difference inintervention completion rate between the two groups (intelligent group: 339 cases [88.5%]， routine group: 337 cases[89.1%], =0.330，P=0.565).The intelligent group had a higher blood pressure control rate (293 cases [86.4%] vs247 cases [73.2%], =18.510,P＜0.001), higher satisfaction score (27.43±1.45 vs 22.97±1.30,t=42.229,P＜0.001),and higher medication adherence score (6.76±0.33 vs 5.22±1.04,t=18.403,P＜0.001) than the routine group. Comparedwith baseline,both groups showed significant increases in estimated glomerular filtration rate (eGFR), high-densitylipoprotein cholesterol (HDL-C), scores of social function,physical function, bodily pain, physical role functioning,vitality,general health, mental health, emotional role functioning,confrontation score, and disease awareness rate (all P＜0.05), aswell as significant decreases in serum creatinine, urea nitrogen, uric acid, blood pressure, 24-hour urinary albumin excreticrate,total cholesterol,triglyceride,low-density lipoprotein cholesterol (LDL-C),resignation, and avoidance scores (all P＜0.05). Improvements were significantly more pronounced in the intelligent group than in the routine group (all P＜0.05). Logistic regression showed that the intelligent model (OR=0.351,95%CI: 0.220 to 0.558,P＜0.001), two drug combination(OR-0.487,95%CI:0.323 to 0.735,P=0.001), three drug combination (OR=0.286,95%CI:0.164 to 0.497,P＜0.001), fourdrnug combination (OR=0.216,95%CI:0.080 to 0.589,P=0.003), exercise 1 to 2 times per week (OR=0.599,95%CI:0.388 to 0.926,P=0.021), and exercise ≥ 3 times per week(OR=0.375,95%CI:0.219 to 0.645,P＜0.001) were protective factors forachieving blood pressure control in patients with hypertension and CKD. Conclusion The intelligent model managementcan improve therapeutic outcomes in patients with hypertension and CKD and serves as a protective factor for blood pressurecontrol.

关键词

健康教育 / 智能化模型管理 / 慢性肾脏病 / 高血压

Key words

health education / intelligent model management / chronic kidney disease / hypertension

参考文献

[1] Georgianos PI, Agarwal R . Hypertension in chronic kidney disease—treatment standard 2023[J]. Nephrol Dial Transplant， 2023， 38（12）： 2694-2703.

[2] Kelly DM, Georgakis MK, Franceschini N, et al. Interplay between chronic kidney disease, hypertension, and stroke: insights from a multivariable mendelian randomization analysis[J]. Neurology， 2023， 101（20）： e1960-e1969.

[3] EMPA—KIDNEY collaborative group . Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA—KIDNEY trial[J]. Lancet Diabetes Endocrinol， 2024， 12（1）： 51-60.

[4] Bahall M, Legall G, Lalla C . Depression among patients with chronic kidney disease, associated factors, and predictors: a cross—sectional study.[J]. BMC Psychiatry， 2023， 23（1）： 733.

[5] 何京京, 黄黎霞, 王玉萍, 等 . PBL联合CBL模式在2型糖尿病患者胰岛素注射健康教育中的应用[J]. 中华现代护理杂志， 2024， 30（4）： 521-526.

[6] 陈晓红, 刘红兵, 赖开兰 . 门诊健康教育对乳腺癌患者认知水平和心理状态的影响[J]. 中国妇幼保健， 2020， 35（23）： 4408-4411.

[7] 陈源源, 孙宁玲 . 高血压院外互联网管理中国专家共识简介[J]. 中华高血压杂志， 2022， 30（8）： 725-728.

[8] 杨秀秀, 赵磊, 卢瑞存, 等 . "互联网+"医院—家庭联动规范化喂养管理模式在早产儿中的应用[J]. 中华现代护理杂志， 2022， 28（7）： 6.

[9] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中国医疗保健国际交流促进会高血压病学分会, 等 . 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志(中英文)， 2024， 32（7）： 603-700.

[10] 上海市肾内科临床质量控制中心专家组 . 慢性肾脏病筛查、诊断及防治指南(2017年版)[J]. 中国实用内科杂志， 2017， 37（1）： 28-34.

[11] 中华医学会肾脏病学分会专家组 . 中国慢性肾脏病患者高血压管理指南(2023年版)[J]. 中华肾脏病杂志， 2023， 39（1）： 48-80.

[12] 吴建博, 陶竹君, 钱程, 等 . 续配和服药依从性量表在中国老年糖尿病患者中信效度优化及验证[J]. 药物流行病学杂志， 2021， 30（10）： 706-712.

[13] 卢宏伶, 崔益鸿, 翁丽娜, 等 . 全面规范化督导式护理对透析性低血压及生活质量的影响[J]. 现代中西医结合杂志， 2021， 30（36）： 4066-4069.

[14] Li Y, Fang C, Xiong M, et al. Exploring fear of cancer recurrence and related factors among breast cancer patients: a cross—sectional study.[J]. J Adv Nurs， 2024， 80（6）： 2403-2414.

[15] 谢丽, 游倩, 朱丹, 等 . 以造口专科护±为主导的链式管理对肠造口患儿的影响[J]. 护理学杂志， 2024， 39（6）： 46-49.

[16] Yamada S, Nakano T . Role of chronic kidney disease (CKD)—mineral and bone disorder (MBD) in the pathogenesis of cardiovascular disease in CKD.[J]. J Atheroscler Thromb， 2023， 30（8）： 835-850.

[17] Mayne KJ, Sullivan MK, Lees JS . Sex and gender differences in the management of chronic kidney disease and hypertension.[J]. J Hum Hypertens， 2023， 37（8）： 649-653.

[18] 王瑾, 赵小静 . 社区健康宣教联合孕期营养指导在围产期妇幼保健工作中的临床效果[J]. 贵州医药， 2023， 47（6）： 944-946.

[19] 郑颖, 陈晓敏, 彭旺, 等 . 基于互联网+平台的健康宣教及延伸护理对高血压患者的干预效果[J]. 临床与病理杂志， 2022， 42（3）： 715-720.

[20] 宋莹婵茜, 杨青, 文彦 . 基于CFIR框架的"医院—社区—家庭"联动下癌痛患者居家护理促进和障碍因素的质性研究[J]. 护±进修杂志， 2023， 38（21）： 2010-2015.

[21] 沈玉芹, 罗倩, 沈婷, 等 . 慢性心力衰竭患者医院—社区—家庭同质化运动康复服务体系建设探索[J]. 中华全科医师杂志， 2022， 21（4）： 301-308.