目的 为了全面控制高血压危险因素,更好地有效预防及控制疾病,防止心、脑、肾全身脏器的合并症出现,对出院高血压患者采用了规范的"生命网"健康教育流程,并按计划实施健康教育、管理和监督,以使这些患者改变不良生活方式,建立良好的遵医行为.方法 通过基线调查确定患者目前的生活方式,了解患者的生活态度,根据以上情况制定具体的"生命网"健康教育流程,并对患者在出院1年内实施定期的健康教育、咨询指导、跟踪随访等.结果 随访证明患者不良生活方式较基线调查有明显改善(P<0.05或P<0.01).其中患者戒烟率达92.65%,戒酒率达90.20%,能够坚持健康饮食的患者达65.71%,能够坚持运动锻炼的患者达89.71%.结论 规范实施"生命网"健康教育流程,对高血压患者改变不良的生活方式,提高其治疗的依从性,对预防心、脑、肾不良事件的发生有重要的促进作用.%Objective In order to fully control the risk factors resulting from high blood pressure, effectively prevent and control diseases, and avoid the complications of such organs as heart, brain and kidney, we applied the heartcare network education procedure to the high blood pressure patients after discharge and carried out the health education, management and supervision for them in an orderly way so as to change their lifestyles and develop their medical compliance behaviour. Methods Through baseline investigation , patients' lifestyles and their attitudes towards life were understood. We drew up a concrete heartcare network education procedure for the patients and then implemented a one-year-long regular health education, consultation and interview for them. Results The follow-up interviews showed that patients' lifestyles had remarkably improved compared with baseline data ( P ＜ 0. 05 or P ＜0. 01) . The ratio of giving-up smoking was as high as 92. 65％ , that of health food dieting was 65. 71％ , and that of sticking-to physical exercise was 89. 71％ . Conclusion The standardized heartcare network education procedure has played an important part in changing high blood pressure patients' unhealthy lifestyles, improving their medical compliance and promoting the prevention of the complications of such organs as heart, brain and kiclney.
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