运动结合心理疗法对2型糖尿病患者血糖水平的影响

Influence of exercise therapy combined with psychotherapy on the level of plasma glucose in patients with type 2 diabetes

目的:观察运动结合心理疗法治疗前后2型糖尿病患者血糖水平的变化情况。方法:选择2003-01/2004-12在焦作煤业集团中央医院二分院内分泌代谢病科就诊的2型糖尿病患者150例,均知情同意。按入院顺序分为2组,实验组90例,对照组60例。对照组只进行常规治疗,即药物治疗加饮食治疗。实验组在常规治疗的基础上增加运动疗法和心理疗法。①运动疗法:将散步、医疗步行、慢跑有机结合作为常规项目。散步速度缓慢、全身放松,10～30min/次;医疗步行按计划逐渐延长距离、提高步行速度以后可加入爬坡或登阶运动。每日或隔日进行1次;慢跑以有轻度气促,尚能交谈为宜。从5min开始,逐渐延长持续时间。②心理疗法:放松训练20min/次,1次/d;支持性心理疗法为心理健康教育,32次/周,30～45min/次;音乐治疗20～30min/次,1次/d。以上治疗4周为1个疗程,共2个疗程。治疗前检测患者的空腹血糖、餐后2h血糖、糖化血红蛋白水平及24h尿糖定量,治疗后每周检测1次。治疗前后及治疗2个疗程后检测患者各生化指标的变化情况。疗效判定标准:显效为治疗后症状基本消失,空腹血糖<7.2mmol/L,餐后2h血糖<8.3mmol/L,24h尿糖定量<10.8g或血糖24h尿糖定量较治疗前下降30%以上。有效:治疗后症状明显改善,空腹血糖<8.3mmol/L,餐后2h血糖<10.0mmol/L,24h尿糖定量<25.8g或血糖24h尿糖定量较治疗前下降10%以上。无效:治疗后症状无明显改善,血糖、尿糖下降未达到上述指标。结果:150例患者全部进入结果分析,无脱落。①两组患者治疗2个疗程后空腹血糖水平的比较:实验组高于对照组[(6.99±1.35,6.67±0.58)mmol/L,(t=1.963,P<0.05)]。②两组患者治疗2个疗程后24h尿糖定量的比较:实验组显著低于对照组[(0.62±0.31,1.02±0.49)g,(t=3.298,P<0.01)]。③两组患者治疗2个疗程后糖化血红蛋白水平的比较:实验组显著低于对照组[(6.69±0.96)%,(7.15±0.82)%(t=2.580,P<0.01)]。④两组患者治疗2个疗程后的有效率比较:实验组显著高于对照组[98%,76%(χ2=9.21,P<0.01)]。结论:运动结合心理疗法是现代医学治疗糖尿病的进一步完善,该疗法体现出的良好的血糖控制作用,治疗有效率显著优于常规疗法。

AIM： To investigate the changes of plasma glucose in type 2 diabetic patients before and after exercise therapy plus psychotherapy. METHODS： From January 2003 to December 2004, 150 patients with diabetes were selected from the inpatients in the Second Department of Internal Medicine, Second Division of Central Hospital of Jiaozuo Coal Co. Ltd., and all of them were informed consent. According to their hospitalization order, they were divided into experiment group （n=90） and control group（n=60）, Patients in the control group received routine treatment, i.e., drug treatment plus trophotherapy, and those in the experiment received exercise therapy plus psychotherapy besides the routine treatment. ①Exercise therapy： Stroll, medical treatment on foot and jogging were combined organically as the routine exercise items. Stroll was in a slow speed when the whole body was relaxed for 10 to 30 minutes. The medical treatment on foot was planned to prolong the distance gradually, increase the walking speed and then add climbing slope or step everyday or once every another day. Jogging was proper when the patients were a little panting but still able to talking for 5 minutes in the beginning and then longer gradually. ②Psychotherapy： Relaxing exercise was performed 20 minutes once per day; Supportive psychotherapy, a kind of mental health education, was performed 32 times a week, 30 to 45 minutes once; Music therapy was 30 minutes per day. The above treatment was all performed 4 weeks as a course for a total of 2 courses. The patients＇biochemical indexes were detected before treatment and 2 courses after treatment. Criteria for therapeutic effect： Remarkable effect was based on the symptoms disappearing nearly, the level of fasting plasma glucose（FPG） lower than 7.2 mmol/L, the level of 2-hour plasma glucose lower than 8.3 mmol/L, the quantitative content of 24-hour urine glucose less than 10.8 g or the level of plasma glucose at 24-hour urine glucose decreased by higher than 30% as compare with before treatment; Validity was judged based on the symptoms improved obviously after treatment, the level of FPG lower than 8.3 mmol/L, the level of 2-hour plasma glucose lower than 10.0 mmol/L, the quantitative content of 24-hour urine glucose less than 25.8 g or the level of plasma glucose at 24-hour urine glucose decreased by more than 10% as compare with before treatment; Invalidity was based on the symptoms improved unremarkably, the level of plasma glucose or urine glucose lower than the above-mentioned indexes. RESULTS： All the 150 patients were analyzed in the result without loss. ① In the comparison of FPG level between the two groups after 2-course treatment： The level of FPG was significantly higher in the experiment group than in the control group[（6.99±1.35） mmol/L vs （6.67±0.58） mmol/L, t=1.963, P 〈 0.05]. ②In the comparison of quantitative content of 24- hour urine glucose between the two groups after 2-course treatment： It was significantly less in the experiment group than in the control group [（0.62±0.31） g vs （1.02±0.49） g, t=3.298, P 〈 0.01].③In the comparison of glycated ferrohemoglobin level between the two groups after 2-course treatment： It was significantly lower in the experiment group than in the control group[（6.69±0.96）% vs （7.15±0.82）%, t=2.580, P 〈 0.01]. ④In the comparison of effective rate between the two groups after 2-course treatment： It was significantly higher in the experiment group than in the control group（98% vs 76%, x^2=-9.21, P 〈 0.01）. CONCLUSION： The exercise therapy plus psychohherapy is the further improvement in the treatment of diabetes mellitus in modern medicine, which can control the plasma glucose better and has a higher effective rate than routine treatment has.