海口市2型糖尿病患者护理需求及其影响因素研究

Status and Influencing Factors of Health Care Demands among Type 2 Diabetes Mellitus Patients in Haikou

目的探讨海口市2型糖尿病患者对护理的需求及其影响因素。方法于2010年4月—2011年10月,对海口市5家医疗机构的594例2型糖尿病患者进行问卷调查。调查表内容包括:患者的人口社会学特征、基线状况、综合护理需求(包括疾病护理、并发症预防、健康管理)。采用Logistic回归分析患者对糖尿病护理需求的影响因素。结果 (1)594例糖尿病患者中,大学及以上学历者仅53例(8.9%),市医保者342例(57.6%),在三级医院护理经济条件不足(包括费用勉强够、费用不太够及贫困)者310例(52.2%);采用饮食+运动+口服降糖药物治疗者298例(50.2%);并发大血管病变者73例(12.3%),肾病者62例(10.4%)。(2)疾病护理方面:患者对血糖、血压、眼底、足、肝肾功能的定期检查,饮食护理指导,家庭访问的需求高,需求率分别为100.0%(594/594)、99.3%(590/594)和98.7%(586/594)。并发症预防方面:患者对糖尿病眼病、周围神经病变、肾病预防及护理的需求高,需求率分别为100.0%(594/594)、99.3%(590/594)和98.3%(584/594)。健康管理方面:患者对糖尿病知识及糖尿病药物应用的宣教需求高,需求率分别为98.3%(584/594)和96.6%(574/594)。(3)Logistic回归分析显示,饮食+运动治疗、药物治疗方式、并发症的发生、收入均是影响糖尿病患者疾病护理需求的因素(P<0.05);并发症的发生、年龄、药物治疗方式、主要照顾对象为自己是影响糖尿病患者并发症预防需求的因素(P<0.05);并发症的发生、饮食+运动治疗、伴有脑血管疾病、伴有心血管疾病是影响糖尿病患者健康管理需求的因素(P<0.05)。结论海口市2型糖尿病患者文化程度较低,大多采用饮食+运动+口服降糖药物治疗,很少采用胰岛素治疗。患者的护理需求主要来自3个方面——疾病护理、并发症预防、健康管理,影响患者护理需求的因素主要是年龄、饮食+运动治疗、药物治疗方式、是否发生并发症、收入、主要照顾对象及伴发疾病。故根据患者不同的需求,给予个体化、规范化护理管理在今后的慢病管理体系中非常重要。

Objective To investigate the status and influencing factors of health care demands among type 2 diabetes mellitus（T2DM） patients in Haikou.Methods Totally 594 T2DM patients were recruited from 5 medical institutions from April 2010 to October 2011.Demographic characteristics,disease baseline,disease nursing,complications nursing,complication prevention health care management were surveyed among the patients.Logistic regression analysis was conducted to investigate the influencing factors for T2DM nursing needs.Results（1） Among the 594 T2DM patients,only 53 cases（8.9%） had university or above degrees,342 cases（57.6%） had urban medical insurance,310 cases（52.2%） had economic difficulties in the third degree hospitals,298 cases（50.2%） were treated by combining diet,exercise and hypoglycemic drugs,73 cases（12.3%） had macroangiopathy and 62 cases（10.4%） had nephropathy.（2） The needs were high for regular examination of blood glucose,blood pressure,eye ground,foot,liver and kidney functions,diet guidance and family visits,and the demand rate was 100.0%（594 /594）,99.3%（590 /594） and 98.7%（586 /594） respectively.The needs were high for the prevention of diabetic eye diseases,peripheral neuropathy and nephropathy,and the demand rate was 100.0%（594 /594）,99.3%（590/594） and 98.3%（584/594） respectively.The needs for publicity of T2DM knowledge and medicines were high,and the demand rate was 98.3%（584 /594） and 96.6%（574 /594） respectively.（3） Logistic regression analysis showed that diet combined with exercise,medicine treatment,complications and income were all influencing factors for the nursing needs of T2DM patients（P《0.05）.The occurrence of complications,age,medicine treatment and no attending person were influencing factors for the complication prevention needs（P《0.05）.The occurrence of complications,diet combined with exercise treatment,cerebrovascular disease and cardiovascular disease were influencing factors for the health management needs（P《0.05）.Conclusion T2DM patients in Haikou usually have lower education level,and they are mainly treated by combining diet,exercise and hypoglycemic drugs,but they seldom use insulin.The nursing needs are mainly disease nursing,complication prevention and health management.The influencing factors are age,diet combining exercise,medicine treatment,complications,income,attending person and accompanying diseases.It is very important to give characterized and standardized nursing and management for patients for the future chronic disease management system.