社区护理干预对糖尿病并存冠心病患者不良事件的影响

Effect of community-based nursing intervention on incidence rates of adverse events in patients with diabetes mellitus and coronary artery disease

目的探讨社区护理干预模式对降低糖尿病并存冠心病患者不良事件发生率的作用。方法将糖尿病并存冠心病患者226例随机分入干预组(n=103)和对照组(n=123)。干预组患者于社区卫生院接受随访护士提供的每月1次的病情评估、体检及检验、并发症预防、心理护理等护理干预,对于治疗效果不满意或病情变化者,经主管医生调整治疗方案后追加随访、更改患者用药方法,对于出现严重异常者立即联系住院治疗;对照组于门诊接受常规护理。结果随访(31.5±16.8)个月,干预组终点事件发生率显著降低(P<0.01);终点事件风险比0.42;两组Kaplan-Meier生存曲线比较,差异有统计学意义(P<0.05);COX回归分析证实终点事件发生的危险因素包括既往6个月住院次数、初诊并存疾病、年龄、使用药物数量(均P<0.01)。结论社区护理干预模式可为糖尿病并存冠心病患者提供连续、长期、可靠的院外护理支持及疗效随访,有效降低此类患者的死亡及严重并发症发生率。

Objective To evaluate the effect of a community-based nursing intervention model on the incidence rates of adverse events in patients with diabetes mellitus（DM） and coronary artery disease（CAD）. Methods Totally, 226 patients with DM and CAD were enrolled and randomized into an intervention group of 103 and a control group of 123. The intervention group received community-based nursing intervention：the community nurses assessed their conditions, ran physical checkups and biological tests for them;they took measures against complications, and gave psychological care, etc,on monthly basis; for those who were not satisfied with treat- ment effect or those who presented a sudden change in their conditions, the charge physicians adjusted treatment plans, made more frequent follow-ups, and prescribed other medicines; for those who developed severe anomalies, the charge physicians referred them to a hospital for further treatment. The control group received routine nursing care at outpatient clinics. Results The partici- pants were followed-up for （31.5±16.8） months, the rate of adverse events at the end points were significantly decreased （P〈0.05） in the interverntion group than in the control gruop,with a hazard ratio of 0.42 between the two groups . The differences between the Kaplan-Meier survival curves of the two groups also had statistical significance （P（0.05）. COX regression analysis confirmed that the risk factors for adverse events at the end points included times of hospitalization in the past 6 months, primary comorbidities, ages, numbers of medications taken （P〈0.01 for all）. Conclusion The model of community-based nursing intervention provides patients with DM and CAD with sustained, longterm and reliable out-of-hospital care and follow-ups, which decreases the mortality rate and incidence rates of severe complications.