细节护理管理在老年冠心病合并2型糖尿病患者疾病控制的有效性研究

The effect of intensive nursing care management in disease control in elder patients with coronary heart disease and type 2 diabetes mellitus

目的探讨细节护理管理在老年冠心病合并2型糖尿病患者疾病控制中的有效性。方法选择2017年1月~2018年2月在海口医院就诊的184例老年冠心病合并2型糖尿病患者,依据随机数字的方法分为对照组(n=92)和观察组(n=92),对照组给予常规护理干预,观察组在对照组患者基础上给予细节护理管理。对比两组住院时间和医疗费用、并发症、出院6个月后的疾病管理能力和生活质量。结果观察组住院时间(10.13±2.33)d和医疗费用(8763.51±1354.82)元均少于对照组住院时间(14.07±2.94)d和医疗费用(10478.91±3200.51)元,差异有统计学意义(t=10.074、4.734,P<0.05)。观察组患者低血糖发生率(2.17%)和心律失常发生率(4.35%)均低于对照组低血糖发生率(9.78%)和心律失常发生率(14.13%),差异有统计学意义(χ2=4.738、5.250,P<0.05)。观察组认知管理(22.21±2.41)分、服药管理(21.17±2.57)分、症状管理(21.32±1.77)分、情绪管理(20.89±1.86)分和行为管理(19.93±1.76)分均高于对照组认知管理(18.13±2.13)分、服药管理(17.61±2.66)分、症状管理(18.85±1.98)分、情绪管理(18.34±2.03)分和行为管理(17.23±1.97)分,差异均有统计学意义(t=-12.167、-9.232、-8.921、-8.884、-9.803,P<0.05)。观察组活动受限程度(88.12±9.81)分、心绞痛稳定状态(84.35±9.77)分、心绞痛发作情况(93.65±11.65)分、治疗满意度(88.91±10.09)分和疾病主观感受(70.61±9.85)分均高于对照组活动受限程度(67.83±8.98)分、心绞痛稳定状态(73.61±10.35)分、心绞痛发作情况(82.34±8.98)分、治疗满意度(77.61±12.61)分和疾病主观感受(62.35±10.61)分,差异均统计学意义(t=-14.700、-7.238、-7.375、-6.711、-5.472,P<0.05)。结论利用细节护理管理干预冠心病合并2型糖尿病的老年患者,可以改善患者在住院期间的疗效,提升出院之后的远期疾病控制效果。

Objective To discuss the effect of intensive nursing care management in disease control in elderly patients with coronary heart disease(CHD)and type 2 diabetes mellitus.Methods 184 elderly patients with CHD and type 2 diabetes treated in Haikou Hospital from January 2017 to February 2018 were enrolled and were divided into control group(n=92)and observation group(n=92)according to the random number table method.Patients in the control group received routine nursing care,while those in the observation group also received intensive nursing care management.Length of hospital stay,medical expenses,complications,disease management ability and quality of life after 6 months of discharge were compared between the two groups.Results The length of hospital stay was shorter and medical expense was lower in the observation group than those in the control group(10.13±2.33 vs 14.07±2.94 d;8763.51±1354.82 vs 10478.91±3200.51 yuan),the differences were statistically significant(t=10.074,4.734,P<0.05).The incidence of hypoglycemia(2.17%)and arrhythmia(4.35%)in the observation group were significantly lower than those in the control group(χ~2=4.738,5.250,P<0.05).The scores of cognitive management(22.21±2.41),medication management(21.17±2.57),symptom management(21.32±1.77),emotional management(20.89±1.86)and behavioral management(19.93±1.76)in the observation group were significantly higher than those in the control group(18.13±1.76,17.61±2.66,18.85±1.98,18.34±2.03,17.23±1.97)(t=-12.167,-9.232,-8.921,-8.884,-9.803,P<0.05).The scores of activity limitation(88.12±9.81),stable state of angina pectoris(84.35±9.77),attack of angina(93.65±11.65),treatment satisfaction(88.91±10.09)and subjective feeling of disease(70.61±9.85)in the observation group were significantly higher than those in the control group(67.83±8.98,73.61±10.35,82.34±8.98,77.61±12.61,62.35±10.61)(t=-14.700,-7.238,-7.375,-6.711,-5.472,P<0.05).Conclusions Intensive nursing care management can improve the therapeutic effect in elderly patients with coronary heart disease and type 2 diabetes mellitus during hospital stay and also improve the long-term disease control after discharge.