协同护理联合健康指导在 2 型糖尿病合并骨质疏松症 患者中的应用效果论文

　    　Application effects of collaborative care combined with health guidance in patients with type 2 diabetes mellitus complicated with osteoporosis

　　       ZHU Liping

　　(1st Department of Endocrinology ofAnyang People’s Hospital,Anyang 455000 Henan,China)

 
　　【Abstract】Objective:To observe application effects of collaborative care combined with health guidance in patients with type 2 diabetes mellitus complicated with osteoporosis.Methods:A prospective study was performed on 84 patients with type 2 diabetes mellitus complicated with osteoporosis admitted to this hospital from May 2019 to May 2021.These patients were divided into control group and observation group by random number table method,42 cases in each group.The control group was given health guidance,while the observation group was given collaborative care on the basis of that of the control group.The levels of blood glucose indicators[fasting blood glucose(FBG),2-h postprandial blood glucose(2hBG),glycated hemoglobin(HbA1c)],the bone mineral density,and the self-care ability[exercise of self-care agency scale(ESCA)]score were compared between the two groups before and after the intervention.Results:After the intervention,the levels of FBG,2hBG and HbA1c in the two groups were lower than those before the intervention,those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The bone mineral density levels of L2-4,Wards triangle,femoral neck and greater trochanter in both groups were higher than those before the intervention,those of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).Further,the scores of self-care ability such as self-concept,self-care responsibility,self-care skills and health knowledge level in both groups were higher than those before the intervention,those of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusions:The collaborative care and health guidance for the patients with type 2 diabetes mellitus complicated with osteoporosis can reduce the levels of blood glucose indicators,and improve the bone mineral density and the self-care ability scores.Moreover,it is superior to single health guidance.

　　【Keywords】Collaborative care;Health guidance;Type 2 diabetes mellitus;Osteoporosis;Blood glucose;Bone mineral density;Self-care ability

　　2型糖尿病患者长期高血糖可损伤肾脏，在排出葡萄糖的同时也会排出大量钙，易使患者并发骨质疏松，增加骨折风险[1]。糖尿病合并骨质疏松患者日常需通过降糖药、饮食调节、运动锻炼等方式控制血糖，给予骨健康补充剂以改善骨质疏松状况，但患者依从性较差，需加强健康宣教[2]。健康指导虽可在一定程度上提高患者的疾病认知水平和依从性，但存在患者缺乏自我护理能力、家属参与度低等问题，干预效果不甚理想。协同护理是护士指导患者执行自我照护活动，充分发挥患者潜能，同时鼓励家属参与并帮助和监督患者完成自我护理行为，强化三者的协同作用，进而提高护理质量[3]。本文观察协同护理联合健康指导在2型糖尿病合并骨质疏松症患者中的应用效果。

        1 资料与方法

 

　　1.1一般资料选取2019年5月至2021年5月本院收治的84例2型糖尿病合并骨质疏松症患者进行前瞻性研究。纳入标准：符合中国《2型糖尿病防治指南(2013年版)》中2型糖尿病诊断标准[4]及《中国骨质疏松性骨折诊疗指南》中骨质疏松症诊断标准[5]；认知功能正常、沟通能力良好。排除标准：患有甲状旁腺功能亢进或其他可干扰骨代谢的疾病；关节破坏严重；临床资料不全。患者及家属均知情本研究内容并签署知情同意书，本研究经本院医学伦理委员会批准(批准文号：15241545)。采用随机数字表法将患者分为对照组(n=42)和观察组(n=42)。对照组：男21例，女21例；年龄35~50岁，平均(41.30±2.19)岁；病程1~15年，平均(8.22±1.23)年。观察组：男20例，女22例；年龄35~50岁，平均(41.69±2.55)岁；病程2~15年，平均(8.12±1.26)年。两组一般资料比较，差异无统计学意义(P>0.05)，有可比性。
 

 

　　1.2方法两组均遵医嘱给予降糖治疗并补充钙剂。对照组采用健康指导。向患者发放健康手册并举办专题讲座，讲解糖尿病和骨质疏松症相关知识，包括病因、病机、症状及治疗方法等，嘱患者少食糖分、淀粉或脂肪含量高的食物，多食富含纤维、高钙食物及豆制品，遵循少食多餐原则，严格控制饮食。

　　观察组在对照组基础上采用协同护理。(1)建立良好护患关系。积极与患者沟通，了解其具体病情、心理状态并向患者分享恢复良好病例资料，引导患者诉说内心想法并为其答疑解惑，营造温馨舒适的病房环境。(2)实施协同护理。责任护士向患者及其家属讲解协同护理内容、方法、意义并要求患者家属协同护士督导患者健康行为。医师每日查房时强化健康宣教，耐心解答患者疑问，护士通过微信群向患者及其家属定期推送疾病发病、治疗相关知识及自我护理技能，并强调患者个人自理能力对病情康复的积极作用，也可邀请恢复良好者分享自身如何通过自我护理来加快康复，鼓励患者提出问题并及时解答；定期组织病友交流会，邀请患者与家属一同参加并鼓励其分享自我护理经验。家属协同医护督导患者监测血糖、合理饮食；根据患者具体情况制订个性化饮食方案；出院后，指导患者在家属陪同下循序渐进地进行运动锻炼；指导患者家属帮患者按摩、推拿疼痛部位，必要时入院复查。两组均持续干预1个月。1.3观察指标(1)比较两组干预前后血糖指标水平。采用血糖仪检测空腹血糖(FBG)、餐后2 h血糖(2hBG)和糖化血红蛋白(HbA1c)水平。(2)比较两组干预前后骨密度。采用EXA-PRESTO型X射线骨密度测定仪(Osteosys Co.Ltd.，国械注进20152301019)测量患者L2~4、Wards三角区、股骨颈及大转子骨密度。(3)比较两组干预前后自护能力评分。采用自我护理能力量表(ESCA)评估[6]，ESCA包括自我概念(8个条目)、自护责任感(6个条目)、自我护理技能(12个条目)和健康知识水平(17个条目)，各条目0~4分，总分172分，分值越高表示自我护理能力越强。1.4统计学方法采用SPSS 18.0软件进行统计学分析，计量资料以(±s)表示，采用t检验，计数资料以率(%)表示，采用χ2检验，以P<0.05为差异有统计学意义。