基于云数据的门诊高血压监测

doi:10.16150/j.1671-2870.2020.03.021

摘要/Abstract

摘要：

目的： 调查基于云数据的门诊血压管理系统在实际监测高血压患者血压中的作用。方法： 数字化监测系统包括具有蓝牙功能的血压计、医师端操作系统和健康管理平台;选取上海交通大学医学院附属瑞金医院2018年1月1日至2018年12月31日间,通过健康云平台进行血压监测管理的高血压患者7 933例,按首次和末次血压监测间隔时间分为6组,间隔2个月组（3 901例）、3个月组（1 562例）、4个月组（930例）、5个月组（615例）、6个月组（428例）和﹥6个月组（497例）,回顾性分析患者血压的变化幅度、首及末次血压监测分布情况,比较高血压分级,分析血压的时效关系等。结果： 采用健康云平台进行分析发现,与基线水平相比,各组间的收缩压平均下降了8.88 mmHg（95%CI为 8.79~8.98,P<0.001）,舒张压平均下降了5.25 mmHg（95%CI为5.23~5.27,P<0.001）。高血压的分级和人群分布均得到改善,高血压分级由首次的1级、2级、3级分别为69%、23%和8%,到末次高血压分级为正常高血压39%、1级39%、2级17%和3级5%,差异均有统计学意义（P<0.001）。进一步分析该血压管理云系统对血压控制的量效性和时效性,结果显示,经第一次监测后患者的血压即开始下降,并在后续监测下呈稳定状态。结论： 基于云数据服务的健康管理平台,可以辅助临床对门诊高血压患者的血压监测管理。

关键词: 高血压, 数字化监测, 真实世界研究

Abstract:

Objective: To implement a cloud-based solution for hypertension management in an outpatient setting and to assess the efficacy of cloud-based solution on control of blood pressure (BP). Methods: A cloud-based solution was developed, consisting of a Bluetooth-enabled BP monitor, a physician-end App, a cloud engine with knowledge database offering personalized lifestyle management and medication adherence contents. During Jan 1st 2018 and Dec 31st 2018, a total of 7 933 hypertensive patients were recruited into this study at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into six different groups according to the intervention duration (2 months, 3 months, 4 months, 5 months, 6 months and more than 6 months). Changes in SBP, DBP, and final BP measurement distribution and hypertension staging as well as the time-effectiveness of the solution were studied. Results: The study population showed an average reduction in SBP by 8.88 mmHg (95%CI: 8.79-8.98, P<0.001), and DBP by 5.25 mmHg (95%CI: 5.23-5.27, P<0.001), respectively, in the before-after analysis. Hypertension staging distribution in the patients was improved, and the distribution at baseline vs last follow-up were normal BP, 0% vs 39%; stage-1, 69% vs 39%; stage-2, 23% vs 17%; and stage-3, 8% vs 5% (P<0.001). Further study revealed that BP reduction occurred after the first intervention and the reduction remained stably over time. Conclusions: The cloud-based solution might serve as an important tool for assisting BP management in outpatient clinic.

Key words: Hypertension, Cloud-based solution, Real-world study

中图分类号:

R544.1

黄永艳, 杨丽娜, 曹久妹, 王巍. 基于云数据的门诊高血压监测[J]. 诊断学理论与实践, 2020, 19(03): 319-324.

HUANG Yongyan, YANG Lina, CAO Jiumei, WANG Wei. Cloud-based solution assisted blood pressure management in outpatient setting[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(03): 319-324.

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血压	例数（n）	监测时间
血压	例数（n）	基线时	第1次	第2次	第3次	第4次
收缩压（mm Hg）
1级	526	145.00 （144.33~145.67）	138.02 （136.67~139.38）	138.74 （137.37~140.11）	137.09 （135.58~138.60）	140.34 （138.82~141.87）
2级	182	159.35 （157.66~161.03）	148.36 （145.70~151.03）	145.71 （143.02~148.40）	146.32 （143.50~149.15）	147.62 （144.52~150.72）
3级	63	178.06 （171.94~184.19）	153.49 （147.58~159.41）	150.92 （144.73~157.11）	149.68 （143.08~156.29）	149.10 （142.72~155.47）
舒张压（mm Hg）
1级	526	86.47 （85.70~87.24）	83.37 （82.33~84.41）	83.76 （82.75~84.77）	87.72 （81.67~83.77）	84.00 （83.00~85.00）
2级	182	96.73 （95.36~98.10）	90.16 （88.15~92.17）	88.30 （86.31~90.28）	88.84 （86.94~90.73）	88.25 （86.36~90.14）
3级	63	108.24 （104.35~112.13）	96.71 （92.28~101.15）	93.97 （89.46~98.48）	93.05 （88.88~97.22）	94.03 （89.64~98.42）