目的 观察社区综合防治健康管理模式对社区高血压患者血压控制疗效及药物经济学的影响。方法 收集2012年7月—2013年7月广州参与研究的三级医院及社区卫生服务中心收治的原发性高血压病患者2 383例,病例入组后随机分为综合管理组和常规治疗组。记录及随访两组高血压患者基线血压值、降压药物使用方案、是否更换药物、血压控制疗效及药物经济学相关费用情况。结果 与常规治疗组相比,综合管理组患者血压治疗效果较好,显效率及总有效率提高[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001];高血压治疗及管理的药物费用虽有升高(t=16.186,P＜0.001),但相关的门诊费用、住院费用、护理费用及总费用降低(t=25.647, t=35.785, t=22.274,t=73.710,P＜0.001);在降压方案方面,从减少抗高血压药物使用,减少费用考虑,单独用药方式适合单纯性轻度高血压患者,从费用效果分析上,成本效果比以单药组最低,联用药组逐渐增大;增量成本-效果比:二药联用降压方案优于其他降压联合方案,因而两药联用降压为兼顾疗效和成本的降压较佳组合。结论 应用社区综合防治模式对高血压患者进行干预,效果满意,能够有效降低成本-效果比,值得临床推广应用。

Objective To investigate the effects of comprehensive prevention and control measures on the therapeutic efficient and pharmacoeconomics in community hypertension patients. Methods 2383 cases of hypertension were collected from July 2012 to July 2013 in the tertiary and community hospitals in Guangzhou, which were randomly divided into general therapy group, in which the patients were treated by general administration of drugs, and comprehensive management group that the patients were visited regularly. The sources of drugs, drugs use and changes in drugs were investigated. Results Compared with the general therapy group, better treatment effects were achieved in the comprehensive group. The apparent efficiency and total efficiency were both increased in the comprehensive group[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001]. Although the therapy and pharmacy fees were slightly increased in the comprehensive group as compared to the control group (t=16.186, P＜0.001), the outpatient expenses,hospitalization expenses, nursing expenses and the total expenses were decreased(t=25.647; t=35.785; t=22.274;t=73.710;P＜0.001). Considering reducing the use of drugs and decreasing the cost, the method of using single drug is beneficial to the patients of low-risk mild hypertension. The method of using calcium antagonist is the most economical and reasonable way. Conclusion Standardizing management of hypertension in community is effective in improving hypertension treatment and decreasing the cost, which is thus worth popularizing.

目的 探讨不同用药方案治疗慢性阻塞性肺病所致肺部感染的药物经济学。方法 本次医学研究选择我院2012年1月—2014年1月收治的200例慢性阻塞性肺病所致肺部感染患者为观察对象,随机将其分为A组、B组、C组和D组,A组观察对象接受盐酸莫西沙星治疗,B组观察对象接受硫酸依替米星治疗,C组观察对象接受头孢哌酮钠治疗,D组观察对象接受他唑巴坦钠/哌拉西林钠治疗,回顾分析四组观察对象药物经济学。结果 四组观察对象药物敏感度对比差异有统计学意义(P<0.05),而临床治疗效果和不良反应发生率对比则差异无统计学意义(P>0.05)。结论 慢性阻塞性肺病所致肺部感染患者接受C方案治疗,具有理想的临床效果和较高的药物经济学效率。