基于慢性病联合诊治中心为平台的医院-社区一体化管理对2型糖尿病患者治疗效果的研究  

Effects of hospital-community integrated management based on the joint diagnosis and treatment center for chronic diseases in patients with type 2 diabetes mellitus

作　　者：费扬 余少初 孙丽琴 袁春钢 楼琴华 江敏 张芳英 董凤芹[3] 

机构地区：[1]杭州市富阳区第一人民医院内分泌科,杭州311400 [2]富阳区春江社区卫生服务中心全科,杭州311400 [3]浙江大学医学院附属第一医院内分泌科,杭州310003

出　　处：《中华危重症医学杂志（电子版）》2017年第3期176-181,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：杭州市卫生科技计划项目(2014B50)

摘　　要：目的研究以慢性病联合诊治中心为平台的医院-社区一体化管理对2型糖尿病患者的治疗效果。方法将122名糖尿病患者分为对照组(62例)和干预组(60例)。干预组纳入医院-社区一体化管理临床路径,对照组依据传统模式进行管理,对所有患者干预前后的糖化血红蛋白(HbA1c)、空腹血糖、餐后2 h血糖、血压、血脂、尿微量白蛋白/肌酐及质量指数(BMI)进行比较,并且评估各指标干预前后的达标率。结果干预组患者干预后HbA1c[(6.6±3.0)%vs.(7.7±1.4)%,t=2.792,P=0.031]、空腹血糖[(6.7±1.2)mmol/L vs.(8.4±2.4)mmol/L,t=5.134,P=0.005]、餐后2 h血糖[(9.5±2.3)mmol/L vs.(11.0±2.8)mmol/L,t=3.286,P=0.008]及总胆固醇[(5.1±1.4)mmol/L vs.(5.9±1.9)mmol/L,t=2.527,P=0.012]水平较干预前均有明显降低,且干预后HbA1c(47/60 vs.33/60,χ~2=7.350,P=0.007)、空腹血糖(49/60 vs.39/60,χ~2=4.261,P=0.039)、餐后2 h血糖(49/60 vs.29/60,χ~2=14.650,P<0.001)、血压(45/60 vs.33/60,χ~2=5.167,P=0.038)及甘油三酯(33/60 vs.21/60,χ~2=4.089,P=0.044)的达标率较干预前均有明显升高。而对照组上述各指标干预前后比较,差异均无统计学意义(P均>0.05)。结论以慢性病联合诊治中心为平台的医院-社区一体化管理模式对2型糖尿病的治疗效果显著。Objective To study the clinical effects of hospital-community integrated management based on the joint center of diagnosis and treatment for chronic disease in patients with type 2 diabetes mellitus. Methods A total of 122 type 2 diabetes mellitus patients were randomly divided into the control group （n=62） and treatment group （n=60）. Patients in the treatment group were managed by the joint diagnosis and treatment center for chronic disease after they were established management files, while patients in the control group were managed according to the previous diabetes management mode. The levels of glycated hemoglobin （HbA1c）, fasting blood glucose, 2 h postprandial blood glucose, blood pressure, blood lipid, urine microalbumin/createnine and body mass index （BMI） were detected. And the standard reaching rate of above indicators were compared between before and 24 months after the management. Results The levels of HbA1c [（6.6 ± 3.0）% vs. （7.7 ± 1.4）%, t=2.792, P=0.031], fasting blood glucose [（6.7 ± 1.2） mmol/L vs. （8.4 ± 2.4） mmol/L, t=5.134, P=0.005], 2 h postprandial blood glucose [（9.5 ± 2.3） mmol/L vs. （11.0 ± 2.8） mmol/L, t=3.286, P=0.008] and total cholesterol [（5.1 ± 1.4） mmol / L vs. （5.9 ± 1.9） mmol / L, t = 2.527, P = 0.012] in the treatment group before the management were much lower than those after the management, and the standard reaching rate of HbA1c （47/60 vs. 33/60, χ^2=7.350, P=0.007）, fasting blood glucose （49/60 vs. 39/60, χ^2=4.261, P=0.039）, 2 h postprandial blood glucose （49/60 vs. 29/60, χ^2 = 14.650, P〈0.001）, blood pressure （45/60 vs. 33/60, χ^2=5.167, P=0.038） and triglyceride （33/60 vs. 21/60, χ^2=4.089, P=0.044） in the treatment group before the management were much higher than those after the management. However, the above indicators in the control group all showed no significant differences between before and 24 months after the management （all P〈0.05）. Conclusion The therapeutic effect of ho

关 键 词：糖尿病 2型 慢性病 一体化管理 治疗效果 

分 类 号：R587.1[医药卫生—内分泌]