社区护理干预2型糖尿病合并冠心病患者的临床疗效观察与分析
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摘要
目的:观察分析社区护理干预2型糖尿病合并冠心病患者的临床康复和治疗效果。方法:选取2015年1月-2016年7月本社区门诊就诊的2型糖尿病合并冠心病患者,分为社区护理组和常规观察组。社区护理组63例,建立健康档案,按照要求开展健康教育,进行系统规范的饮食、运动、药物、心理等护理干预及病情监测12个月。常规观察组63例,未建立健康档案管理,只开展随机门诊常规护理指导,未进行系统规范健康教育、饮食、运动、药物、心理等护理干预等。两组患者均观察12个月。结果:干预12个月后,社区护理组血糖、血压、心率控制情况、用药依从性、心绞痛和低血糖发生率、各项心功能指标和认知评分等均明显优于常规观察组,差异均有统计学意义(P<0.05),社区护理组血浆同型半胱氨酸(Hcy)、脂蛋白相关磷脂酶A2(Lp-PLA2)水平均明显低于常规观察组,差异均有统计学意义(P<0.05)。结论:干预后血浆Hcy、Lp-PLA2水平的显著降低是2型糖尿病合并冠心病患者恢复效果较好和血脂等指标水平改善的可能机制。系统的社区护理干预具有较好的针对性和可行性,可充分体现出社区护理的整体优势和特色。
Objective:To observe the clinical rehabilitation and treatment effects of community nursing on patients with type 2 diabetes mellitus complicated with coronary atherosclerotic heart disease(CHD).Method:Patients with type 2 diabetes mellitus complicated with CHD from January 2015 to July 2016 in our community were selected and divided into community care group and routine observation group.The community care group was established health records,carried out health education according to requirements,conducted systematic standardized diet,exercise,drugs,psychological and other nursing interventions and condition monitoring for 12 months.The routine observation group was not included in the health record management patient group,only randomized routine nursing guidance,no systematic standardized health education,and dietary interventions such as diet,exercise,drugs,and psychology.Two groups were observed for 12 months.Result:After 12 months of care intervention,the blood glucose,blood pressure,heart rate control,medication compliance,angina pectoris and hypoglycemia,various cardiac function indicators and cognitive scores in the community care group were significantly better than those in the community care group(P<0.05).Plasma homocysteine(Hcy)and Lipoprotein associated phospholipase A2(Lp-PLA2)in the community care group were significantly lower than those in the conventional observation group,the differences were statistically significant(P<0.05).Conclusion:The significant decrease of plasma Hcy and Lp-PLA2 levels after intervention is a possible mechanism for the improvement of the recovery of type 2 diabetes mellitus patients complicated with CHD and the improvement of serum lipid levels.The systematic community nursing intervention has a better pertinence and feasibility.It can fully reflect the overall advantages and characteristics of community nursing.
Objective:To observe the clinical rehabilitation and treatment effects of community nursing on patients with type 2 diabetes mellitus complicated with coronary atherosclerotic heart disease(CHD).Method:Patients with type 2 diabetes mellitus complicated with CHD from January 2015 to July 2016 in our community were selected and divided into community care group and routine observation group.The community care group was established health records,carried out health education according to requirements,conducted systematic standardized diet,exercise,drugs,psychological and other nursing interventions and condition monitoring for 12 months.The routine observation group was not included in the health record management patient group,only randomized routine nursing guidance,no systematic standardized health education,and dietary interventions such as diet,exercise,drugs,and psychology.Two groups were observed for 12 months.Result:After 12 months of care intervention,the blood glucose,blood pressure,heart rate control,medication compliance,angina pectoris and hypoglycemia,various cardiac function indicators and cognitive scores in the community care group were significantly better than those in the community care group(P<0.05).Plasma homocysteine(Hcy)and Lipoprotein associated phospholipase A2(Lp-PLA2)in the community care group were significantly lower than those in the conventional observation group,the differences were statistically significant(P<0.05).Conclusion:The significant decrease of plasma Hcy and Lp-PLA2 levels after intervention is a possible mechanism for the improvement of the recovery of type 2 diabetes mellitus patients complicated with CHD and the improvement of serum lipid levels.The systematic community nursing intervention has a better pertinence and feasibility.It can fully reflect the overall advantages and characteristics of community nursing.
引文
[1]孙婧,崔欣.多样化护理模式在糖尿病合并冠心病患者中的应用观察[J/OL].临床医药文献电子杂志,2015,2(24):5073-5076.
[2]自成文,范兴珍.2型糖尿病合并冠心病与糖尿病非冠心病患者血脂、血糖和胰岛素含量的比较分析[J].中国实用医药,2014,9(5):53-54.
[3]高巧云.多样化护理措施在糖尿病合并冠心病护理中的应用效果[J].现代医药卫生,2017,33(15):2370-2371.
[4]高秀梅,孙凤,张文越,等.护理干预对糖尿病合并冠心病患者的临床效果[J].当代医学,2017,23(20):168-169.
[5]郑纪玉.多样性护理在糖尿病合并冠心病患者中的应用效果[J/OL].中西医结合心血管病电子杂志,2015,3(8):158-159.
[6]Avery L,Sniehotta F F,Denton S J,et al.Movement as Medicine for Type 2 Diabetes:Protocol for an Open Pilot Study and External Pilot Clustered Randomized Controlled Trial to Assess Acceptability,Feasibility and Fidelity of a Multifaceted Behavioural Intervention Targeting Physical Activity in Primary Care[J].Trials.2014(15):46.
[7]中华人民共和国卫生部.冠状动脉粥样硬化性心脏病诊断标准[S].北京:中国标准出版社,2010:1-14.
[8]李秀娟,顾婷,何清.糖尿病合并冠心病患者应用多样性护理方式的干预效果[J].当代护士旬刊,2017(4):20-22.
[9]杨广英.糖尿病合并冠心病病人的饮食治疗及护理进展[J].内蒙古中医药,2017,36(1):114-116.
[10]何燕梅.整体护理模式在糖尿病合并冠心病患者中的应用效果分析[J].承德医学院学报,2016,33(5):402-404.
[11]李晶.多样性护理方式在糖尿病合并冠心病患者护理中的应用效果分析[J/OL].中西医结合心血管病电子杂志,2015,3(36):139-140.
[12]陈丽琴.探讨多样性护理在糖尿病合并冠心病护理中的应用[J].世界最新医学信息文摘,2016,16(58):156-157
[13]刘榴.多样性护理在糖尿病合并冠心病护理中的应用效果分析[J/OL].临床医药文献电子杂志,2017,4(51):9996-9997.
[14]李英.多样性护理方式在糖尿病合并冠心病患者中的应用效果[J].中国当代医药,2015,22(24):181-186.
[15]邢佳玲.糖尿病合并心脏病的护理体会[J].医学美学美容(中旬刊),2014(8):316.
[16]卢丽华,张小玲.多样性护理方式在糖尿病合并冠心病患者中的应用效果观察[J].糖尿病新世界,2017,20(2):122-124.
[17]Dayal S,Baumbach G L,Arning E,et al.Deficiency of superoxide dismutase promotes cerebral vascular hypertrophy and vascular dysfunction in hyperhomocysteinemia:[J].PLoS One,2017,12(4):e0175732.
[18]秦召敏,沈钦海,孔瑞雪.血浆Lp-PLA2、MIP-1α、GPIb与冠心病冠状动脉粥样硬化病变严重程度的关系[J].重庆医学,2017,46(24):3411-3413.
[19]Ikonomidis I,Kadoglou N N,Tritakis V,et al.Association of Lp-PLA2 with digital reactive hyperemia,coronary flow reserve,carotid atherosclerosis and arterial stiffness in coronary artery disease.[J].Atherosclerosis,2014,234(1):34-41.
[2]自成文,范兴珍.2型糖尿病合并冠心病与糖尿病非冠心病患者血脂、血糖和胰岛素含量的比较分析[J].中国实用医药,2014,9(5):53-54.
[3]高巧云.多样化护理措施在糖尿病合并冠心病护理中的应用效果[J].现代医药卫生,2017,33(15):2370-2371.
[4]高秀梅,孙凤,张文越,等.护理干预对糖尿病合并冠心病患者的临床效果[J].当代医学,2017,23(20):168-169.
[5]郑纪玉.多样性护理在糖尿病合并冠心病患者中的应用效果[J/OL].中西医结合心血管病电子杂志,2015,3(8):158-159.
[6]Avery L,Sniehotta F F,Denton S J,et al.Movement as Medicine for Type 2 Diabetes:Protocol for an Open Pilot Study and External Pilot Clustered Randomized Controlled Trial to Assess Acceptability,Feasibility and Fidelity of a Multifaceted Behavioural Intervention Targeting Physical Activity in Primary Care[J].Trials.2014(15):46.
[7]中华人民共和国卫生部.冠状动脉粥样硬化性心脏病诊断标准[S].北京:中国标准出版社,2010:1-14.
[8]李秀娟,顾婷,何清.糖尿病合并冠心病患者应用多样性护理方式的干预效果[J].当代护士旬刊,2017(4):20-22.
[9]杨广英.糖尿病合并冠心病病人的饮食治疗及护理进展[J].内蒙古中医药,2017,36(1):114-116.
[10]何燕梅.整体护理模式在糖尿病合并冠心病患者中的应用效果分析[J].承德医学院学报,2016,33(5):402-404.
[11]李晶.多样性护理方式在糖尿病合并冠心病患者护理中的应用效果分析[J/OL].中西医结合心血管病电子杂志,2015,3(36):139-140.
[12]陈丽琴.探讨多样性护理在糖尿病合并冠心病护理中的应用[J].世界最新医学信息文摘,2016,16(58):156-157
[13]刘榴.多样性护理在糖尿病合并冠心病护理中的应用效果分析[J/OL].临床医药文献电子杂志,2017,4(51):9996-9997.
[14]李英.多样性护理方式在糖尿病合并冠心病患者中的应用效果[J].中国当代医药,2015,22(24):181-186.
[15]邢佳玲.糖尿病合并心脏病的护理体会[J].医学美学美容(中旬刊),2014(8):316.
[16]卢丽华,张小玲.多样性护理方式在糖尿病合并冠心病患者中的应用效果观察[J].糖尿病新世界,2017,20(2):122-124.
[17]Dayal S,Baumbach G L,Arning E,et al.Deficiency of superoxide dismutase promotes cerebral vascular hypertrophy and vascular dysfunction in hyperhomocysteinemia:[J].PLoS One,2017,12(4):e0175732.
[18]秦召敏,沈钦海,孔瑞雪.血浆Lp-PLA2、MIP-1α、GPIb与冠心病冠状动脉粥样硬化病变严重程度的关系[J].重庆医学,2017,46(24):3411-3413.
[19]Ikonomidis I,Kadoglou N N,Tritakis V,et al.Association of Lp-PLA2 with digital reactive hyperemia,coronary flow reserve,carotid atherosclerosis and arterial stiffness in coronary artery disease.[J].Atherosclerosis,2014,234(1):34-41.