链式管理在农村空巢老年糖尿病患者胰岛素注射中的应用研究

doi:10.3761/j.issn.0254-1769.2022.23.013

摘要/Abstract

摘要：

目的评价链式管理对农村空巢老年糖尿病患者胰岛素注射管理能力的影响。方法以村为单位实施整群随机抽样法，2021年1月—12月，选取96例在县域联盟单位接受胰岛素治疗的老年糖尿病患者，使用随机数字表法将患者分为试验组和对照组，各48例。试验组接受链式管理，对照组接受常规管理。干预前及干预后3、6个月，比较两组胰岛素注射管理能力、血糖代谢指标、生存质量及胰岛素注射并发症发生率。结果 91例患者完成了研究。干预后3、6个月，试验组胰岛素注射管理能力总分高于对照组，差异有统计学意义（P<0.05）。2组空腹血糖、餐后2 h血糖在干预前及干预后3、6个月的比较，差异有统计学意义（P_组间<0.001，P_时间=0.002，P_交互=0.002；P_组间<0.001，P_时间=0.015，P_交互=0.016）；2组糖化血红蛋白的组间比较，差异有统计学意义（P_组间<0.001）；干预后6个月，两组生存质量特异性量表各条目及总分的比较，差异均有统计学意义（P<0.05）；干预后6个月，两组皮下脂肪增生及疼痛发生率的比较，差异均有统计学意义（P=0.020，P=0.040）。结论实施链式管理能提升农村空巢老年糖尿病患者的胰岛素注射管理能力，有助于控制血糖，改善患者的生存质量，提高注射的安全性。

关键词: 空巢老年人, 糖尿病, 胰岛素, 链式管理, 护理管理研究

Abstract:

Objective To evaluate the effects of chain management on insulin injection management ability of rural empty nest elderly diabetic patients. Methods The randomized controlled study was conducted to select 96 elderly diabetic patients who started insulin therapy in county alliance units from January 2021 to December 2021 by convenient sampling method. They were divided into an experimental group and a control group by random number table method，with 48 cases in each group. The control group was given routine outpatient care and follow-up management，and the experimental group was given insulin injection chain management. The insulin injection management ability，blood glucose metabolism index，quality of life and incidence of insulin injection complications were compared between the 2 groups after intervention. Results A total of 91 patients completed the study. The scores of insulin injection management ability in the experimental group increased gradually 3 months and 6 months after intervention，and the difference was statistically significant（P<0.05）. There were significant differences in fasting blood-glucose and 2-hour postprandial blood glucose between the 2 groups before intervention，3 months after intervention and 6 months after intervention（P_group<0.001，P_time=0.002，P_interaction=0.002，P_groups<0.001，P_time=0.015，P_interaction=0.016）. There was significant difference in HbA1c between the 2 groups. There were significant differences in DSQL items and total scores between the 2 groups after intervention（P<0.05）. There were significant differences in the incidence of lipohypertrophy and pain between the 2 groups at 6 months after intervention（P=0.020，P=0.040）. Conclusion The implementation of chain management can improve the management ability of insulin injection in rural empty nest elderly diabetic patients，help to control blood glucose smoothly，improve the quality of life of patients，and improve the safety of injection.

Key words: Empty-Nest Elderly, Diabetes, Insulin, Chain Management, Nursing Management Reasearch

吕忠美, 杨小华, 席巍, 葛春燕, 储红梅, 赵杨秋, 王煦, 史爱华. 链式管理在农村空巢老年糖尿病患者胰岛素注射中的应用研究[J]. 中华护理杂志, 2022, 57(23): 2904-2911.

LÜ Zhongmei, YANG Xiaohua, XI Wei, GE Chunyan, CHU Hongmei, ZHAO Yangqiu, WANG Xu, SHI Aihua. Effect of chain management on insulin injection management ability of rural empty nest elderly diabetic patients[J]. Chinese Journal of Nursing, 2022, 57(23): 2904-2911.

图/表 5

表1 两组一般资料的比较

Table 1 Comparison of general data between 2 groups

表2 两组胰岛素注射管理能力的比较[分，M（P25，P75）]

Table 2 Comparison of scores of insulin injection management ability between 2 groups[score，M（P25，P75）]

表3 两组血糖代谢指标的比较（

\bar{x}

±s）

Table 3 Comparison of glucose metabolism indexes between 2 groups before and after intervention（

\bar{x}

±s）

表3 两组血糖代谢指标的比较（ $\bar{x}$ ±s）

Table 3 Comparison of glucose metabolism indexes between 2 groups before and after intervention（ $\bar{x}$ ±s）

表4 两组生存质量特异性量表得分的比较（分，

\bar{x}

±s）

Table 4 Comparison of DSQL scores between 2 groups before and after intervention（score，

\bar{x}

±s）

表4 两组生存质量特异性量表得分的比较（分， $\bar{x}$ ±s）

Table 4 Comparison of DSQL scores between 2 groups before and after intervention（score， $\bar{x}$ ±s）

表5 两组皮下脂肪增生和疼痛发生率的比较 [例（百分率，%）]

Table 5 Comparison of incidence of Lipohypertrophy and pain between two groups[case（percent，%）]

参考文献 22

[1]	《中国老年型糖尿病防治临床指南》编写组. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志, 2022, 30(1):2-51.
	Chinese Society of Gerontology Endocrine Metabolism Branch. Clinical guidelines for the prevention and treatment of elderly type 2 diabetes in China(2022 edition)[J]. Chin J Diabetes, 2022, 30(01):2-51
[2]	贾红红, 刘丽, 罗小茜, 等. 认知-预警干预对农村糖尿病治疗延误患者的效果研究[J]. 中华护理杂志, 2022, 57(9):1113-1120. DOI
	Jia HH, Liu L, Luo XX, et al. Effects of cognition-early warning intervention on patients with delayed treatment of diabetes in rural areas[J]. Chin J Nurs, 2022, 57(9):1113-1120. DOI
[3]	方慧, 唐茂婷, 施雁. 延续性护理在空巢老年糖尿病患者中的研究进展[J]. 护士进修杂志, 2019, 34(12):1096-1099.
	Fang H, Tang MT, Shi Y. Research progress of continuity nursing in empty nest elderly diabetic patients[J]. J Nurses Train, 2019, 34(12):1096-1099.
[4]	李玉东. 南阳地区空巢老年糖尿病患者自我管理水平与生活质量相关性研究[J]. 护士进修杂志, 2019, 34(13):1228-1230,1243.
	Li YD. Correlation between self-management level and quality of life of empty nest elderly diabetic patients in Nanyang area[J]. J Nurses Train, 2019, 34(13):1228-1230,1243.
[5]	American Diabetes Association. 12 older adults:standards of me-dical care in diabetes-2021[J]. Diabetes Care, 2021, 44(suppl 1):S168-S179. DOI URL
[6]	张明霞, 赵芳, 袁丽, 等. 31个省份各级医院胰岛素注射院内管理现状调查与分析[J]. 中华护理杂志, 2022, 57(5):594-601. DOI
	Zhang MX, Zhao F, Yuan L, et al. Investigation and analysis of the status of insulin injection management in hospitals at all levels in 31 provinces and autonomous regions[J]. Chin J Nurs, 2022, 57(5):594-601. DOI
[7]	高倩倩, 梅凡, 赵黎, 等. 老年糖尿病患者衰弱发生率的系统评价[J]. 中华护理杂志, 2021, 56(5):686-693. DOI
	Gao QQ, Mei F, Zhao L, et al. Prevalence of frailty in older patients with diabetes:a systematic review[J]. Chin J Nurs, 2021, 56(5):686-693.
[8]	王非凡, 屈红, 刘晓轶. 医联体合作模式下链式管理在延续护理中的实践[J]. 护理学杂志, 2021, 36(19):1-4.
	Wang FF, Qu H, Liu XY. Practice of chain management assisted continuous nursing care under the model of medical collaboration alliance[J]. J Nurs Sci, 2021, 36(19):1-4.
[9]	顾洁, 张茵英. 基于链式管理模式的多学科联合健康教育对门诊高血压患者服药依从性的影响[J]. 解放军护理杂志, 2019, 36(5):54-57.
	Gu J, Zhang YY. Effect of multi-disciplinary combined health education on the drug compliance of outpatient with hypertension based on chain management mode[J]. Nurs J Chin PLA, 2019, 36(5):54-57.
[10]	钟娜, 胡琼燕, 梁旭霞, 等. 医院-社区母乳喂养链式管理模式的应用及效果评价[J]. 中华护理杂志, 2022, 57(14):1669-1675. DOI
	Zhong N, Hu QY, Liang XX, et al. Application and effect evaluation of a hospital-community breastfeeding chain management model[J]. Chin J Nurs, 2022, 57(14):1669-1675. DOI
[11]	周雅婷, 张柠, 辛园园, 等. 基于管理协同理论的国内外医疗机构上下联动工作机制分析[J]. 中国医院, 2021, 25(2):1-4.
	Zhou YT, Zhang N, Xin YY, et al. Research on the vertical linkage mechanism of medical and health institutions in China and abroad based on synergistic management theory[J]. Chin Hosp, 2021, 25(2):1-4.
[12]	赵杨秋, 蔡义红, 杨小健, 等. 分级诊疗体系背景下基层护理专科联盟的构建与实施[J]. 循证护理, 2019, 5(11):1014-1017.
	Zhao YQ, Cai YH, Yang XJ, et al. Construction and implementation of primary care specialist alliance under the background of a hierarchical diagnosis and treatment system[J]. Chin Evid Based Nurs, 2019, 5(11):1014-1017.
[13]	国家老年医学中心,中华医学会老年医学分会,中国老年保健协会糖尿病专业委员会. 中国老年糖尿病诊疗指南(2021年版)[J]. 中华糖尿病杂志, 2021, 13(1):14-46.
	National Center of Gerontology,Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well Association. Guideline for the management of diabetes mellitus in the elderly in China(2021 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(1):14-46.
[14]	李光琴. 胰岛素使用访谈工具在2型糖尿病患者授权教育中的应用研究[D]. 长沙: 湖南师范大学, 2020.
	Li GQ. The application of insulin interview tool in empowerment education on the adult patients with type 2 diabetes mellitus[D]. Changsha: Hunan Normal University, 2020.
[15]	王煦, 杨小华, 储红梅, 等. 基于Kano模型的2型糖尿病症状管理微信平台服务需求[J]. 中华健康管理学杂志, 2022, 16(4): 276-278.
	Wang X, Yang XH, Chu HM, et al. Research on functional requirements of symptom management wechat platform of type 2 diabetes based on Kano model[J]. Chin J Health Manag, 2022, 16(4):276-278.
[16]	孔利萍, 任小萍, 葛华英, 等. Swanson关怀理论在糖尿病患者胰岛素注射教育中的应用效果[J]. 中华全科医学, 2020, 18(8):1409-1413.
	Kong LP, Ren XP, Ge HY, et al. The application effect of Swanson care theory in insulin injection education for diabetic patients[J]. Chin J Gen Pract, 2020, 18(8):1409-1413.
[17]	廖志红, 周凤琼, 梁奕铨. 生存质量是评价糖尿病治疗的重要指标[J]. 中国糖尿病杂志, 2000, 8(5):49-50.
	Liao ZH, Zhou FQ, Liang YQ. Quality of life is an important index to evaluate the treatment of diabetes[J]. Chin J Diabetes, 2000, 8(5):49-50.
[18]	余凤娇, 朱凌燕, 李萍. 基于ORTCC模型的糖尿病专科联盟护理管理实践[J]. 护理学杂志, 2022, 37(3):45-48.
	Yu FJ, Zhu LY, Li P. Improving nursing management based on ORTCC model within the context of diabetes specialty alliance[J]. J Nurs Sci, 2022, 37(3):45-48.
[19]	祝小丹. 家庭医生签约式服务在社区2型糖尿病病人中的应用[J]. 护理研究, 2020, 34(6):1106-1108.
	Zhu XD. Application of family doctor contract service in type 2 diabetes patients in communities[J]. Chin Nurs Res, 2020, 34(6):1106-1108.
[20]	李芹芹, 刘敏, 潘爱红, 等. 线上线下联动教育在基础胰岛素治疗患者中的应用[J]. 护理学杂志, 2022, 37(6):81-84,91.
	Li QQ, Liu M, Pan AH, et al. Application of online and in-person joint education mode to patients on basal insulin therapy[J]. J Nurs Sci, 2022, 37(6):81-84,91.
[21]	程娇娇, 刘贝贝, 苏蕴, 等. 空巢与非空巢老年人综合失能状况及其影响因素研究[J]. 中国全科医学, 2022, 25(15):1833-1837,1844. DOI
	Cheng JJ, Liu BB, Su Y, et al. Prevalence and influencing factors of comprehensive disability in empty and non-empty nesters[J]. Chin Gen Pract, 2022, 25(15):1833-1837,1844.
[22]	高芳凤, 王荣兰, 车春, 等. 习惯养成教育对2型糖尿病患者胰岛素规范注射知信行水平及生活质量的影响[J]. 中国健康教育, 2019, 35(10):940-943.
	Gao FF, Wang RL, Che C, et al. The effect of habit formation education on the knowledge,belief,and practice(KBP) level of Insulin standard injection and quality of life among patients with type 2 diabetes[J]. Chin J Health Educ, 2019, 35(10):940-943.

编辑推荐 0

Metrics

阅读次数

全文

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	0	0	0	12

	来源	本网站

	次数	12
	比例	100%

摘要

437

最新录用	在线预览	正式出版

0	0	437

	来源	本网站

	次数	437
	比例	100%