基于奥马哈系统的DR患者延续护理方案的构建及应用研究  

Development and Application of a Continuity of Care Program for Diabetic Retinopa⁃thy Patients Based on the Omaha System

作　　者：胡哲[1] 雷丹丹 赵益 高月[1] 杨阳 代晶 HU Zhe;LEI Dandan;ZHAO Yi;GAO Yue;YANG Yang;DAI Jing(Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院,武汉430060

出　　处：《中国中医眼科杂志》2024年第1期89-94,共6页China Journal of Chinese Ophthalmology

基　　金：湖北省重点实验室开放项目(2021KFH027)。

摘　　要：目的探讨基于奥马哈系统的糖尿病视网膜病变(DR)患者延续护理方案的构建及应用研究。方法选取2022年1月15日—2022年5月31日在武汉大学人民医院眼科中心接受治疗的DR患者104例,随机分为观察组和对照组,各52例。对照组实施常规DR护理及出院指导,观察组实施以奥马哈系统为框架构建的延续护理方案,每个月实施1次,连续干预6个月。比较2组患者干预前、后自我管理水平评分,空腹血糖,餐后2 h血糖,糖化血红蛋白及眼底筛查率。结果(1)护理问题:观察组患者共存在护理问题591个,平均每位患者存在11.36个护理问题。(2)自我管理能力:干预后对照组各项得分及总分均较干预前升高(t_(饮食)=16.261、t_(运动)=5.949、t_(血糖监测)=5.609、t_(足部护理)=7.298、t总分=19.147,均P=0.000);干预后观察组各项得分及总分均较干预前升高(t_(饮食)=32.370、t_(运动)=14.915、t_(血糖监测)=13.248、t_(足部护理)=42.670、t总分=45.475,均P=0.000);干预后观察组各项得分及总分均高于对照组(t_(饮食)=9.091、t_(运动)=11.996、t_(血糖监测)=11.192、t_(足部护理)=38.894、t总分=29.149,均P=0.000),差异均有统计学意义。(3)血糖控制:干预后对照组患者餐后2 h血糖和糖化血红蛋白水平均较干预前降低(t_(餐后血糖)=2.245,P=0.029;t_(糖化血红蛋白)=7.607,P=0.000),干预后观察组患者空腹血糖、餐后2 h血糖和糖化血红蛋白水平均较干预前降低(t_(空腹血糖)=5.477、t_(餐后血糖)=5.748、t_(糖化血红蛋白)=13.101,均P=0.000),干预后观察组患者空腹血糖、餐后2 h血糖和糖化血红蛋白水平均低于对照组(t_(空腹血糖)=4.865、t_(餐后血糖)=5.174、t_(糖化血红蛋白)=7.836,均P=0.000),差异均有统计学意义。(4)眼底筛查率:干预后观察组眼底筛查率为94.23%,高于对照组53.85%,差异有统计学意义(χ^(2)=22.061,P=0.000)。结论对DR患者构建并实施基于奥马哈系统的延续护理,�OBJECTIVE To explore the construction and application of a continuity of care program for diabetic retinopathy(DR)patients based on the Omaha System.METHODS A total of 104 DR patients treated at the Eye Center of Renmin Hospital of Wuhan University from January 15th,2022,to May 31st,2022,were randomly divided into an observation group and a control group,with 52 patients in each group.The control group received routine DR care and discharge guidance,while the observation group received a continuity of care program built on the Omaha System,implemented once a month for six consecutive months.The self-management level,fasting blood glucose(FBG),postprandial 2-hour blood glucose(PBG),glycated hemoglobin(GH),and retinal screening rates were compared between the two groups before and after the intervention.RESULTS(1)Nursing problems:The observation group had a total of 591 nursing problems,with an average of 11.36 nursing problems per patient. (2) Self-management ability: After the intervention, the scores of various items and the total score in the control group increased compared to before the intervention (t_(diet)=16.261, t_(exercise)= 5.949, t_(blood glucose monitoring)=5.609, t_(foot care)=7.298, ttotal score=19.147, all P=0.000). After the intervention, the observation group´s scores for various items and the total scores increased compared to before the intervention (t_(diet)=32.370, t_(exercise)=14.915, t_(blood glucose monitoring)=13.248, t_(foot care)=42.670, ttotal score=45.475, all P=0.000). After the intervention, the observation group´s scores for various items and the total score were higher than those in the control group (t_(diet)=9.091, t_(exercise)=11.996, t_(blood glucose monitoring)= 11.192, t_(foot care)=38.894, ttotal score=29.149, all P=0.000), with statistically significant differences. (3) Blood glucose control: After the intervention, the levels of postprandial 2 hours blood glucose and glycated hemoglobin in the control group decreased compared to before the intervention (t_(PBG)= 2.245,

关 键 词：奥马哈系统 延续护理 糖尿病视网膜病变 自我管理 眼底筛查 

分 类 号：R473.77[医药卫生—护理学]