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目的分析阿司匹林在社区管理的高血压和糖尿病患者中的应用现状,为高血压和糖尿病患者心血管疾病预防提供依据。方法收集浙江省宁波市鄞州区7个乡镇2013年高血压和糖尿病随访管理信息和社区门诊诊疗系统信息。根据《中国心血管病预防指南(2011)》推荐的标准,判断研究对象是否应服用阿司匹林,计算阿司匹林使用率,用SAS 9.2软件进行2个独立样本率的χ~2检验。结果通过身份证号将社区管理的高血压和糖尿病患者的随访信息与社区门诊诊疗系统信息进行匹配,发现在社区门诊就诊过的高血压患者15 006例,糖尿病患者4 059例。在高血压患者中,符合一级预防者共7 517例,阿司匹林者使用率为15.19%,不同性别间使用率差异无统计学意义(P>0.05);符合二级预防者共2 120例,阿司匹林者使用率为43.73%,男性的使用率高于女性,差异有统计学意义(χ~2=4.471,P<0.05)。在糖尿病人群中,一级预防阿司匹林使用率为17.86%,不同性别间使用率差异无统计学意义(P>0.05);二级预防阿司匹林使用率为53.70%,男性的使用率高于女性,差异有统计学意义(χ~2=9.460,P<0.01)。一级预防中,高血压合并糖尿病者阿司匹林使用率最高,为18.97%。结论在社区管理的高血压和糖尿病患者中,阿司匹林的使用率过低,尤其是一级预防的使用率。应进一步加强对社区医生阿司匹林预防性用药的培训,提高社区医生将阿司匹林用于心血管疾病预防的意识,进一步提高阿司匹林在心血管疾病患者和高危人群中的应用。
Objective To analyze the current status of aspirin in community-managed hypertension and diabetes mellitus, and provide evidence for the prevention of cardiovascular disease in patients with hypertension and diabetes mellitus. Methods The 2013 hypertension and diabetes follow-up management information and community outpatient diagnosis and treatment system information were collected from 7 townships in Yinzhou District, Ningbo City, Zhejiang Province. According to the recommended criteria of “Prevention Guide for Cardiovascular Disease of China (2011)”, whether aspirin should be taken or not should be calculated. Aspirin use rate should be calculated. Two independent sample rate χ ~ 2 tests should be performed with SAS 9.2 software. Results The community-managed hypertension and diabetic follow-up information was matched with community outpatient medical system information by ID number, and 15 006 hypertensive patients and 4 059 diabetic patients were found in outpatient community clinics. Among hypertensive patients, 7517 patients were eligible for primary prevention, 15.19% were aspirin, and there was no significant difference in the use rates among different sexes (P> 0.05). A total of 2 120 patients were eligible for secondary prevention, Aspirin use rate was 43.73%, male use rate was higher than female, the difference was statistically significant (χ ~ 2 = 4.471, P <0.05). In the diabetic population, the primary prevention aspirin use rate was 17.86%, and there was no significant difference in the use rate among different sexes (P> 0.05). The secondary prevention aspirin use rate was 53.70%, the male use rate was higher than the female, the differences There was statistical significance (χ ~ 2 = 9.460, P <0.01). Primary prevention, hypertension and aspirin use the highest rate of diabetes was 18.97%. Conclusions In community-managed hypertension and diabetes mellitus, the rate of aspirin use is too low, especially for primary prevention. Further training of community doctors on aspirin prophylaxis should be stepped up to raise the awareness of community doctors about the use of aspirin in the prevention of cardiovascular disease and to further improve the use of aspirin in patients with cardiovascular disease and in at-risk populations.