综合性评估与个体化干预对糖尿病患者伤口愈合和生存质量的影响

Effects of comprehensive evaluation and individualized intervention on wound healing and quality of life in diabetic patients

目的探讨综合性评估及个体化干预对糖尿病患者合并的慢性伤口及生存质量的影响效果。方法选取2016年9月～2017年8月河北省唐山市开滦总医院和河北省唐山市唐山工人医院两所医院收治的糖尿病合并慢性伤口患者88例,按照随机数字表法将其分为干预组和对照组,每组各44例。在给予湿性愈合治疗基础上,干预组给予综合性评估及个体化连续性干预措施,对照组实施常规护理措施。采用压疮愈合计分表(PUSH)评价两组患者伤口愈合情况及比较各阶段伤口愈合天数,采用健康调查量表(SF-36)比较干预后两组生存质量。结果干预后第7、14、21天,两组患者PUSH计分均显著低于干预前,差异均有统计学意义(P <0.05)。干预后第7天两组PUSH计分比较,差异无统计学意义(P> 0.05),干预后第14、21天,干预组PUSH计分低于对照组,差异有统计学意义(P <0.05)。干预组伤口愈合达到25%、50%、75%和100%时所用天数均明显少于对照组,差异有统计学意义(P <0.05)。干预组干预后SF-36各维度评分均显著高于干预前,差异均有统计学意义(P <0.05),对照组干预后仅在生理功能、生理职能及躯体疼痛方面较干预前有所改善,差异有统计学意义(P <0.05)。干预后,干预组生理功能、躯体疼痛、精力、社会功能、精神健康和总体健康评分均高于对照组,差异有统计学意义(P <0.05)。结论通过综合性评估,给予糖尿病合并慢性伤口患者个体化干预,可加快伤口愈合速度,改善患者生存质量。

Objective To explore the effect of comprehensive evaluation and individualized intervention on chronic wounds and quality of life of patients with diabetes mellitus. Methods From September 2016 to August 2017, in Hebei Province Kailuan General Hospital and Tangshan Gongren Hospital, 88 patients of diabetes mellitus with chronic wounds were selected and divided into intervention group and control group according to the random number table method, with 44 cases in each group. Based on the wet healing treatment, the intervention group was given comprehensive assessment and individualized intervention, the control group was given the routine nursing measures. Pressure ulcer scale for healing （PUSH） was used to evaluate the wound healing status of the two groups and compare the wound healing days at each stage.The health survey scale （SF-36） was used for comparing the quality of life in the two groups after intervention. Results After intervention for 7, 14, 21 days, the PUSH score of the two groups were significantly lower than those before intervention, the differences were statistically significant （P 〈 0.05）. The comparison of PUSH score between the two groups on the 7th day after intervention showed no statistically significant difference （P 〈 0.05）. After intervention for 14, 21 days, the PUSH score of the intervention group were lower than those of the control group, the differences were statistically significant （P 〈 0.05）. The duration of wound healing at 25%, 50%, 75% and 100% of the intervention group were significantly shorter than those of the control group, the differences were statistically significant （P 〈 0.05）. After intervention, the SF-36 scores in each dimension of the intervention group were higher than those before intervention, the differences were statistically significant （P 〈 0.05）, while the control group showed improvement in physiological function, physiological function and body pain comparing with those before intervention, the differences were statistically significant （P 〈 0.05）. After intervention, the physiological function, physical pain, energy, social function, mental health and overall health scores of the intervention group were higher than those of the control group, the differences were statistically significant （P 〈 0.05）. Conclusion Through comprehensive evaluation, the individualized intervention on the diabetes mellitus patients with chronic wounds can accelerate the wound healing speed and improve the quality of life.