三位一体慢性病管理模式对非增殖期糖尿病视网膜病变患者的效果分析  

Effect of trinity chronic disease management model on patients with non-proliferative diabetic retinopathy

作　　者：晁媛媛 陈晓冬 梁乐[2] 王丽娜[3] Chao Yuanyuan;Chen Xiaodong;Liang Le;Wang Lina(Department of Ophthalmology,Xi'an First Hospital,Xi'an 710002,China;Department of Pharmacy,Xi'an First Hospital,Xi'an 710002,China;Department of Ophthalmology,The First Affiliated Hospital of Northwest University,Xi'an 710043,China)

机构地区：[1]西安市第一医院眼科,西安710002 [2]西安市第一医院药剂科,西安710002 [3]西北大学附属第一医院眼科,西安710043

出　　处：《国际医药卫生导报》2025年第5期875-880,共6页International Medicine and Health Guidance News

基　　金：陕西省重点研发计划(2023-YBSF-637,2024SF-YBXM-340);西安市科技计划(2022YXYJ0079)。

摘　　要：目的研究医院-社区-家庭三位一体慢性病管理模式在非增殖期糖尿病视网膜病变(NPDR)患者健康管理中的应用效果。方法前瞻性选取2021年10月至2023年5月期间在西安市第一医院首次就诊的NPDR患者136例,将患者随机分为对照组和观察组,每组68例。对照组男42例,女26例,年龄(59.7±9.1)岁,病程≥5年48例;观察组男35例,女33例,年龄(60.5±8.6)岁,病程≥5年41例。对照组实施常规管理,观察组实施医院-社区-家庭三位一体慢性病管理模式。两组均连续干预3个月。比较两组视力、血糖指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)及糖化血红蛋白(HbA1c)]及血糖控制率,干预前后简易疾病感知问卷(BIPQ)、糖尿病视网膜病变患者自我管理量表、糖尿病患者特异性生存质量量表(DSQL)评分及经济负担水平。统计学分析采用独立样本t检验、χ^(2)检验、秩和检验。结果干预3个月后,观察组患者的视力改善有效率高于对照组[61.77%(42/68)比30.88%(21/68)],视力下降率低于对照组[4.42%(3/68)比20.59%(14/68)],差异有统计学意义(χ^(2)=15.956,P=0.001);FPG、2hPG、HbA1c水平均低于对照组[(7.95±1.29)mmol/L比(9.08±1.31)mmol/L、(10.27±1.25)mmol/L比(11.39±1.28)mmol/L、(6.94±0.36)%比(8.48±0.39)%],差异均有统计学意义(均P<0.05);FPG、2hPG、HbA1c控制率均高于对照组[27.94%(19/68)比2.94%(2/68)、39.71%(27/68)比20.59%(14/68)、57.35%(39/68)比22.06%(15/68)],差异均有统计学意义(均P<0.05);BIPQ、DSQL评分及经济负担均低于对照组[(44.59±3.24)分比(57.57±4.63)分、(41.34±3.07)分比(52.37±3.41)分、(1.98±0.51)万元比(2.37±0.64)万元],自我管理能力评分高于对照组[(95.52±6.64)分比(83.71±4.58)分],差异均有统计学意义(t=18.941、19.823、4.683、12.073,均P<0.05)。结论实施医院-社区-家庭三位一体慢性病管理模式有利于改善NPDR患者视力,控制血糖水平,提高患者疾病感知能力、自我管理能力及生活质量Objective To study the effect of hospital-community-family trinity chronic disease management model in the health management of non-proliferative diabetic retinopathy(NPDR).Methods A total of 136 patients with NPDR who received their first treatment in Xi'an First Hospital from October 2021 to May 2023 were prospectively selected and were randomly divided into a control group and an observation group.In the control group,there were 42 males and 26 females,aged(59.7±9.1)years,48 patients with≥5 years of disease course.In the observation group,there were 35 males and 33 females,aged(60.5±8.6)years,41 patients with≥5 years of disease course.The control group received routine management,and the observation group received hospital-community-family trinity chronic disease management model for 3 months.Visual acuity,blood glucose indexes[fasting blood glucose(FPG),2 h postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)],and blood glucose control rate of the two groups were observed.The scores of Brief Illness Perception Questionnaire(BIPQ),Diabetic Retinopathy Patient Self-management Scale,and Diabetes Specific Quality of Life Scale(DSQL)and economic burden were compared between the two groups before and after intervention.Independent sample t test,χ^(2) test,and rank sum test were used for statistical analysis.Results After 3 months of intervention,the effective rate of visual acuity improvement in the observation group was higher than that in the control group[61.77%(42/68)vs.30.88%(21/68)],and the rate of visual acuity decline was lower than that in the control group[4.42%(3/68)vs.20.59%(14/68)],with a statistically significant difference(χ^(2)=15.956,P=0.001);the levels of FPG,2hPG,and HbA1c in the observation group were lower than those in the control group[(7.95±1.29)mmol/L vs.(9.08±1.31)mmol/L,(10.27±1.25)mmol/L vs.(11.39±1.28)mmol/L,(6.94±0.36)%vs.(8.48±0.39)%],the control rates of FPG,2hPG,and HbA1c were higher than those in the control group[27.94%(19/68)vs.2.94%(2/68),39.71%(27/68)vs

关 键 词：非增殖期糖尿病视网膜病变 医院-社区-家庭 三位一体管理模式 血糖控制 疾病感知 自我管理能力 经济负担 

分 类 号：R58[医药卫生—内分泌]