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目的探讨内分泌专科护士—社区全科护士—患者分级随访干预对糖尿病(Diabetes Mellitus,DM)患者低血糖发生的影响。方法选取260例城阳区后金社区已建立健康档案的DM患者进行随访干预,青岛市城阳区人民医院内分泌专科护士对社区卫生服务中心全科护士进行1次/月DM知识培训,并进行基线资料问卷调查,根据基线资料是否出现低血糖情况分为低血糖组和非低血糖组,其中低血糖组80例,非低血糖组180例。采用护理干预措施对糖尿病患者进行3个月随访干预治疗,主要由全科护士进行健康宣教包括饮食运动、药物治疗和血糖监测,随访3个月再统计低血糖情况。应用卡方检验分析低血糖患病率,通过logistic回归分析低血糖的原因。结果低血糖发生与合并并发症、年龄、Hb A1c、DM病程及合理生活方式有关;基线夜间、空腹、餐后及餐前低血糖发生率分别为31.30%、20.00%、5.00%及50.00%,3个月低血糖发生率分别为17.50%、11.21%、0及31.30%,差异有统计学意义(P<0.05);基线1次、2次、3次低血糖发生率分别为50.00%、30.00%、20.00%,3个月低血糖发生率分别为31.30%、20.00%、5.00%,差异有统计学意义(P<0.01);基线口服药物、胰岛素治疗、口服药物联合胰岛素治疗及生活方式治疗低血糖发生率分别为15.00%、3.00%、45.00%及5.00%,3个月低血糖发生率分别为5.00%、21.21%、30.00%及0,差异有统计学意义(P<0.01或P<0.05)。结论内分泌专科护士—社区全科护士—患者分级随访干预可以减少DM患者的低血糖发生风险。
Objective To investigate the effect of graded follow-up of endocrine specialist nurses - community nurses - on the incidence of hypoglycemia in Diabetes Mellitus (DM). Methods A total of 260 DM patients with established health record in Houjin Community of Chengyang District were selected for follow-up intervention. Endocrinology nurses in Chengyang District People’s Hospital of Qingdao conducted 1 / month DM training on general health nurses in community health centers and conducted Baseline data questionnaire, based on whether baseline data hypoglycemia cases were divided into hypoglycemia group and non-hypoglycemia group, including 80 cases of hypoglycemia, non-hypoglycemia group of 180 cases. Nursing interventions were used to treat patients with diabetes mellitus for 3 months follow-up intervention. The health education mainly consisted of general nurses including dietary exercise, drug therapy and blood glucose monitoring. The patients were followed up for 3 months and then the hypoglycaemia was measured. The prevalence of hypoglycemia was analyzed by chi-square test and the cause of hypoglycemia was analyzed by logistic regression. Results The incidence of hypoglycemia was associated with complications, age, course of Hb A1c, DM and reasonable lifestyle. The incidences of normoglycemia, fasting, postprandial hypoglycemia were 31.30%, 20.00%, 5.00% and 50.00% respectively at baseline, The incidences of hypoglycemia at 3 months were 17.50%, 11.21%, 0 and 31.30%, respectively, with significant difference (P <0.05). The incidences of primary hypoglycemia at 1, 2 and 3 times were 50.00%, 30.00 The incidence of hypoglycemia in three months was 31.30%, 20.00% and 5.00% respectively, with statistical significance (P <0.01). The baseline oral medication, insulin therapy, oral medication combined with insulin therapy and lifestyle treatment The incidence of hypoglycemia was 15.00%, 3.00%, 45.00% and 5.00%, respectively. The incidence of hypoglycemia in 3 months were 5.00%, 21.21%, 30.00% and 0 respectively, with statistical significance (P <0.01 or P < 0.05). Conclusion Endocrine specialist nurses - community nurses - graded follow-up of patients can reduce the risk of hypoglycemia in DM patients.