以强化生活方式干预为重点的延续护理在儿童青少年1型糖尿病中的应用效果
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摘要
目的探讨以强化生活方式干预为重点的延续护理对儿童青少年1型糖尿病的影响。方法采用便利抽样方法选取2014年3月～2016年10月河北北方学院附属第一医院儿科和内分泌科收治的143例儿童青少年1型糖尿病住院患儿为研究对象,根据患者入院编号随机分为对照组(74例)和干预组(69例)。出院时对照组患者进行常规的出院指导,干预组在此基础上结合为期6个月的以强化生活方式干预为重点的延续护理模式;出院时、干预3个月后、干预6个月后分别通过青少年糖尿病患者生存质量量表(DQOLY)、糖尿病管理自我效能量表(CDMSES)、Likert 5级量表评估患者生存质量、自我管理效能以及依从性,与此同时统计6个月内两组患者再入院人数。结果出院后3、6个月,干预组DQOLY评估情况显著优于对照组(P <0.05),C-DMSES评分均显著高于对照组(P <0.05),且两组C-DMSES评分均较干预前明显升高(P <0.05),干预组依从性情况明显优于对照组(P <0.05);此外,出院后6个月内,对照组因未遵医嘱服药导致再入院、因饮食不规律导致再入院、因糖尿病相关并发症再入院的人数均明显多于干预组(P <0.05)。结论通过以强化生活方式干预为重点的延续护理可以明显改善患者生存质量,提高其满意度和依从性,增强患者自我管理行为的自信心,同时有效降低了出院后短期再入院率。
Objective To explore the effect of intensive lifestyle intervention on type 1 diabetes in children and adolescents Methods A total of 143 childrens and adolescents with type 1 diabetes admitted to the Department of Paediatrics and Endocrinology of the First Affiliated Hospital of Hebei North University from March 2014 to October 2016 were selected by convenient sampling method. According to the admission number of the patients, they were randomly divided into control group(74 cases) and intervention group(69 cases). At discharge, patients in the control group received routine discharge guidance, and the intervention group was combined with a 6 month continuous nursing mode focusing on intensive lifestyle intervention. At discharge, 3 months after intervention and 6 months after intervention,the quality of life scale(DQOLY), diabetes management self-efficacy scale(C-DMSES) and Likert five-level scale were used to evaluate the quality of life, self-management efficacy and compliance of the patients. Meanwhile, thenumber of readmission in the two groups within 6 months was calculated. Results Three months after discharge and 6 months after discharge, DQOLY evalu-ation of the intervention group was significantly better than that of the control group(P < 0.05), C-DMSES score was significantly higher than that of the control group(P < 0.05), and C-DMSES score of the two groups was significantly higher than that of the control group(P < 0.05), and compliance of the intervention group was significantly better than that of the control group(P < 0.05). In addition, within 6 months after discharge, the number of patients in the control group who were readmission due to non-compliance with medicine, readmission due to irregular diet, and readmission due to diabetic complications were significantly higher than those in the intervention group(P < 0.05). Conclusion Continuous nursing with the focus of intensive lifestyle intervention can significantly improve the quality of life of patients, improve their satisfaction and compliance, enhance the self-confidence of patients' self-management behavior,and effectively reduce the short-term readmission rate after discharge.
Objective To explore the effect of intensive lifestyle intervention on type 1 diabetes in children and adolescents Methods A total of 143 childrens and adolescents with type 1 diabetes admitted to the Department of Paediatrics and Endocrinology of the First Affiliated Hospital of Hebei North University from March 2014 to October 2016 were selected by convenient sampling method. According to the admission number of the patients, they were randomly divided into control group(74 cases) and intervention group(69 cases). At discharge, patients in the control group received routine discharge guidance, and the intervention group was combined with a 6 month continuous nursing mode focusing on intensive lifestyle intervention. At discharge, 3 months after intervention and 6 months after intervention,the quality of life scale(DQOLY), diabetes management self-efficacy scale(C-DMSES) and Likert five-level scale were used to evaluate the quality of life, self-management efficacy and compliance of the patients. Meanwhile, thenumber of readmission in the two groups within 6 months was calculated. Results Three months after discharge and 6 months after discharge, DQOLY evalu-ation of the intervention group was significantly better than that of the control group(P < 0.05), C-DMSES score was significantly higher than that of the control group(P < 0.05), and C-DMSES score of the two groups was significantly higher than that of the control group(P < 0.05), and compliance of the intervention group was significantly better than that of the control group(P < 0.05). In addition, within 6 months after discharge, the number of patients in the control group who were readmission due to non-compliance with medicine, readmission due to irregular diet, and readmission due to diabetic complications were significantly higher than those in the intervention group(P < 0.05). Conclusion Continuous nursing with the focus of intensive lifestyle intervention can significantly improve the quality of life of patients, improve their satisfaction and compliance, enhance the self-confidence of patients' self-management behavior,and effectively reduce the short-term readmission rate after discharge.
引文
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[3]董彦会,王政和,杨忠平,等.中国儿童青少年糖尿病患病率Meta分析[J].中国学校卫生,2016,37(11):1676-1679.
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[7]Sumida Y,Yoneda M.Glycogen Hepatopathy:An Underrecognized Hepatic Complication of Uncontrolled Type 1Diabetes Mellitus[J].Intern Med,2018,57(8):1063-1064.
[8]孙冰,王守磊.多学科团队信息化支持与冬夏令营活动的联合延续护理对1型糖尿病青少年患者的影响[J].护理实践与研究,2017,14(4):12-14.
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[11]王坤,仇爱珍.家庭陪伴护理对糖尿病患儿家庭亲密度、适应性及血糖控制的影响分析[J].川北医学院学报,2017,32(5):794-797.
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[13]International C.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2010,33(Suppl 1):S62-S69.
[14]邱翠竹,王明珠,罗少荘,等.青少年1型糖尿病患者生存质量及影响因素的调查研究[J].护士进修杂志,2015(16):1467-1469.
[15]Otto C,Barthel D,Klasen F,et al.Predictors of self-reported health-related quality of life according to the EQ-5D-Y in chronically ill children and adolescents with asthma,diabetes,and juvenile arthritis:longitudinal results[J].Qual Life Res,2018,27(4):879-890.
[16]郑侠,张宁.青少年1型糖尿病患者出院后延续护理的效果研究[J].中华现代护理杂志,2016,22(9):1289-1292.
[17]Oyarzun A,Lera L,Codner E,et al.High concentrations of anti-caspase-8 antibodies in Chilean patients with type 1 diabetes[J].Immunobiology,2011,216(2):208-212.
[18]Vendrame F,Cataldo D,Ciarlo L,et al.In Type 1 Diabetes Immunocompetent cells are defective in IL-16 secretion[J].Scand J Immunol,2012,75(1):127-128.
[19]Badami E,Sorini C,Coccia M,et al.Defective Differentiation of regulatory FoxP3(+)T Cells by small-intestinal dendritic cells in patients with type 1 diabetes[J].Diabetes,2011,60(8):2120-2124.
[20]罗灿明,戴霞,何燕玲,等.强化生活方式干预对空腹血糖受损人群抑郁及血糖影响的研究[J].护理研究,2014,28(2):196-197.
[21]Ikramuddin S,Korner J,Lee WJ,et al.Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c,LDL Cholesterol,and Systolic Blood Pressure at 5Years in the Diabetes Surgery Study[J].JAMA,2018,319(3):266-278.
[22]Johansen MY,MacDonald CS,Hansen KB,et al.Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes:A Randomized Clinical Trial[J].JAMA,2017,318(7):637-646.
[23]杨锡翠,王文平.护理干预在提高1型糖尿病患儿依从性中的作用[J].医药前沿,2017,7(18):238-239.
[24]李乃适,张念荣,李光伟.生活方式干预是预防2型糖尿病的重要举措[J].中华健康管理学杂志,2013,7(5):289-291.
[25]王晓林,蔡尚郎,郑淑芳,等.对社区代谢综合征患者进行强化生活方式干预的效果观察[J].山东医药,2010,50(17):60-61.
[26]李琼,李雨露,胡乾配,等.药物与强化生活方式治疗糖尿病前期疗效的Meta分析[J].重庆医学,2016,45(25):3508-3513.
[27]郑侠,张宁.青少年1型糖尿病患者出院后延续护理的效果研究[J].中华现代护理杂志,2016,22(9):1289-1292.
[2]毛凤星,栗达.儿童青少年1型糖尿病的营养治疗[J].中国临床医生,2015,43(10):9-12.
[3]董彦会,王政和,杨忠平,等.中国儿童青少年糖尿病患病率Meta分析[J].中国学校卫生,2016,37(11):1676-1679.
[4]黄乐.儿童1型糖尿病并发症及预防[J].开卷有益-求医问药,2017(3):33-33.
[5]杨立勇.1型糖尿病微血管并发症特点及应对[J].中国实用内科杂志,2016,36(7):543-546.
[6]Falkowski B,Rogowicz-Frontczak A,Grzelka A,et al.Higher free triiodothyronine concentration is associated with lower prevalence of microangiopathic complications and better metabolic control in adult euthyroid people with type 1 diabetes[J].Endocrine,2018,60(3):458-465.
[7]Sumida Y,Yoneda M.Glycogen Hepatopathy:An Underrecognized Hepatic Complication of Uncontrolled Type 1Diabetes Mellitus[J].Intern Med,2018,57(8):1063-1064.
[8]孙冰,王守磊.多学科团队信息化支持与冬夏令营活动的联合延续护理对1型糖尿病青少年患者的影响[J].护理实践与研究,2017,14(4):12-14.
[9]刘延迪,王红艳,李梅,等.陪伴教育对提高青少年1型糖尿病患者生活质量及家庭亲密度和适应性的效果[J].解放军护理杂志,2016,33(2):26-28.
[10]向蓉,程昕然,何卫兰,等.以家庭为中心的护理对青少年1型糖尿病患者家庭亲密度和适应性及血糖控制的影响[J].医药卫生:文摘版,2017,2(6):00229-00230.
[11]王坤,仇爱珍.家庭陪伴护理对糖尿病患儿家庭亲密度、适应性及血糖控制的影响分析[J].川北医学院学报,2017,32(5):794-797.
[12]张红,王燕,唐云.奥瑞姆自我护理模式对1型糖尿病患儿的临床应用分析[J].实用临床护理学电子杂志,2016,1(7):115-116.
[13]International C.Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2010,33(Suppl 1):S62-S69.
[14]邱翠竹,王明珠,罗少荘,等.青少年1型糖尿病患者生存质量及影响因素的调查研究[J].护士进修杂志,2015(16):1467-1469.
[15]Otto C,Barthel D,Klasen F,et al.Predictors of self-reported health-related quality of life according to the EQ-5D-Y in chronically ill children and adolescents with asthma,diabetes,and juvenile arthritis:longitudinal results[J].Qual Life Res,2018,27(4):879-890.
[16]郑侠,张宁.青少年1型糖尿病患者出院后延续护理的效果研究[J].中华现代护理杂志,2016,22(9):1289-1292.
[17]Oyarzun A,Lera L,Codner E,et al.High concentrations of anti-caspase-8 antibodies in Chilean patients with type 1 diabetes[J].Immunobiology,2011,216(2):208-212.
[18]Vendrame F,Cataldo D,Ciarlo L,et al.In Type 1 Diabetes Immunocompetent cells are defective in IL-16 secretion[J].Scand J Immunol,2012,75(1):127-128.
[19]Badami E,Sorini C,Coccia M,et al.Defective Differentiation of regulatory FoxP3(+)T Cells by small-intestinal dendritic cells in patients with type 1 diabetes[J].Diabetes,2011,60(8):2120-2124.
[20]罗灿明,戴霞,何燕玲,等.强化生活方式干预对空腹血糖受损人群抑郁及血糖影响的研究[J].护理研究,2014,28(2):196-197.
[21]Ikramuddin S,Korner J,Lee WJ,et al.Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c,LDL Cholesterol,and Systolic Blood Pressure at 5Years in the Diabetes Surgery Study[J].JAMA,2018,319(3):266-278.
[22]Johansen MY,MacDonald CS,Hansen KB,et al.Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes:A Randomized Clinical Trial[J].JAMA,2017,318(7):637-646.
[23]杨锡翠,王文平.护理干预在提高1型糖尿病患儿依从性中的作用[J].医药前沿,2017,7(18):238-239.
[24]李乃适,张念荣,李光伟.生活方式干预是预防2型糖尿病的重要举措[J].中华健康管理学杂志,2013,7(5):289-291.
[25]王晓林,蔡尚郎,郑淑芳,等.对社区代谢综合征患者进行强化生活方式干预的效果观察[J].山东医药,2010,50(17):60-61.
[26]李琼,李雨露,胡乾配,等.药物与强化生活方式治疗糖尿病前期疗效的Meta分析[J].重庆医学,2016,45(25):3508-3513.
[27]郑侠,张宁.青少年1型糖尿病患者出院后延续护理的效果研究[J].中华现代护理杂志,2016,22(9):1289-1292.