三级甲等医院一体化糖尿病管理模式的效果探索  

Practice of integrative diabetes management in third-grade class-A hospital in China

作　　者：王焕君[1] 辛英伟[1] 朱菊训[1] 张钟文[1] 周晓君[1] 董建军[2] 廖琳[1] 

机构地区：[1]山东省千佛山医院内分泌科,济南250014 [2]山东大学齐鲁医院内分泌科

出　　处：《中华糖尿病杂志》2012年第9期537-540,共4页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的针对三甲医院的特点，探索糖尿病的一体化管理模式的效果。方法人选2010年6月至2011年6月收治的380例应用胰岛素治疗且无高血压的2型糖尿病患者，采用Excel随机抽样方法分为2组（管理组和对照组），各190例患者。其中管理组患者男性91例，女性99例，年龄（54±8）岁，体质指数（BMI）（25±3）kg／m^2，病程（8±3）年，对照组患者男性88例，女性102例，年龄（56±7）岁，BMI（26±3）kg／m^2，病程（8±3）年，两组一般资料具有可比性。管理组对患者进行一体化糖尿病管理，对照组按三甲医院的常规方式治疗。疗程均为6个月。对两组干预前后效果进行对比分析。两组均数的比较用t检验，方差不齐时用t＇检验。结果治疗后，管理组和对照组空腹血糖、餐后2h血糖、糖化血红蛋白、生活满意度及自信心均较治疗前有明显改善，治疗前后差异均有统计学意义（t’=-182．81-27．74，均P〈0．05）。对照组BMI较治疗前显著增加，差异有统计学意义[（29±4）比（26±3）kg／m^2，t’=-10．51，P〈0．05]，而管理组BMI未见显著增加，差异无统计学意义[（26±3）比（25±3）kg／m^2，t=1．65，P〉0．05]。治疗后，管理组BMI明显低于对照组，差异有统计学意义（t’=-9．47，P〈0．05）。管理组生活满意度、自信心均显著高于对照组，差异均有统计学意义（分别为96％±4％、95％±4％和62％±10％、60％±11％，t’=42．60、41．69，均P〈0．05）；管理组的胰岛素用量及每日药物费用均显著低于对照组[分别为（0．38±0．03）、（0．55±0．07）U·kg^-1·d^-1和（11±3）、（16±6）元／d，t’=-30．77、-9．21，均P〈0．05]。结论糖尿病一体化管理使血糖控制更好，患者更有自信心，而所用的每日药物费用则下降了27．8％。在目前医疗费用超标的情况下，该管理模式值得临床推广。Objective To investigate the effectiveness of integrative diabetes management in thirdgrade class-A hospital. Method Three hundred and eighty insulin-naive type 2 diabetic patients who were going on insulin therapy were enrolled from June 2010 to June 2011. The patients were divided into 2 groups with Excel random sampling, 190 cases in each group： the management group, 91 males and 99 females, aged （54±8） years with a body mass index（BMI） of （25± 3） kg/m^2 and a duration of disease of （8 ±3） years; the control group, 88 males and 102 females, aged （56 ± 7） years with a BMI of （26 ± 3 ）kg/m^2 and a duration of disease of （ 8 ± 3 ） years, the baseline information was comparable between the two groups. Patients in management group received intensive integrative diabetic management and those in control group were given routine therapy for 6 months. The therapeutic effects were compared before and after the treatment and between the groups. The data of the two groups were compared with t test or t＇ test. Results Fasting plasma glucose, two-hour postprandial plasma glucose, glycated hemoglobin Alc, satisfaction on life and self-confidence at the end of the treatments were all significantly improved compared with those before the therapy in both groups （ t＇ = - 182. 81, - 27.74, P 〈 0. 05 ）. The BMI in control group was significantly higher than that before treatment （（29±4） vs （26±3） kg/m^2, t＇ = - 10.51, P〈0.05）, while no significant difference was found in BMI in the management group after the treatment （ （26±3 ） vs （26±3 ） kg/m^2, t = 1.65, P 〉 0. 05 ）. The BMI in management group was significantly higher than that in control group at the end of the treatment （ t＇ = - 9.47, P 〈 0. 05 ）. Satisfaction on life and self-confidence of the patients in the management group significantly improved compared with those in the control group （96% ± 4%, 95% ±4% and 62% 10%, 60% ±11%, respectively; t＇ =42. 60,41.69, both P 〈0.05）.

关 键 词：糖尿病 2型 疾病管理 血糖控制 

分 类 号：R587.1[医药卫生—内分泌]