健康自我管理对糖尿病足患者自我效能及心理状态的影响

Effect of health self-management on the self-efficacy and psychological state of patients with diabetic foot

目的探讨健康自我管理对糖尿病足患者自我效能及心理状态的影响,为促进糖尿病足患者的健康提供科学依据。方法根据入院顺序将144例2型糖尿病足患者分为观察组和对照组,每组各72例。对照组患者采取常规糖尿病足治疗。观察组在对照组常规糖尿病足治疗的基础上实施健康自我管理措施。采用糖尿病自我效能量表(DEES)、症状自评量表(SQL-90)比较两组自我效能和心理状态。记录两组足部症状改善情况。结果干预后,观察组的饮食控制、药物治疗、血糖监测、自我护理、预防及处理高低血糖的水平均较干预前明显提高(P<0.05),且显著高于对照组,差异有统计学意义(P<0.05);SQL-90评价心理状况显示,观察组除偏执因子,其余各因子(躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐惧、精神病性及其他)水平较干预前明显降低,差异均有统计学意义(P<0.05);观察组的足部发凉、足部干燥、足麻木感发生率较干预前明显降低(P<0.05),且发生率显著低于对照组,差异有统计学意义(P<0.05)。结论健康自我管理模式可通过发挥患者的主观能动性提高其自我管理能力,进而改善糖尿病足患者的自我效能和心理状态,值得广泛应用。

Objective To explore the effect of health self-management on the self-efficacy and psychological state of patients with diabetic foot so as to provide scientific evidence for improving their health. Methods According to the order of hospital admission, 144 patients with type 2 diabetic foot were divided into the observation group and control group （each n = 72 ）. Patients in the control group were given conventional treatment of diabetic foot, whereas those in the observation group implemented health self-management besides the treatment given to the control group. Diabetes self-efficacy scale （DEES） and symptom checklist （SQL-90） were used to compare the self-efficacy and psychological state of the two groups. The improvement of foot symptoms in the two groups was recorded. Results After the intervention, the diet control, drug therapy, blood sugar monitoring, self- care, prevention and treatment of hyperglycemia and hypoglycemia in the observation group were significantly increased as com- pared with those before the intervention （ P〈0.05 ） , and were significantly superior to those of the control group, （ P〈0.05 ）. SQL -90 revealed that after the intervention, the scores of factors like somatization, force symptoms, sensitivity to social relations, de- pression, anxiety, hostility, terror, mental illness and other symptoms in the observation group were significantly lowered than those before the intervention （P〈0.05） , while the symptoms including cold feet, dry foot and numbness of foot were significantly improved （ P〈0.05 ） , and their incidence rates were significantly lower than the control group （ P〈0.05 ）. Conclusions Health self-management activates the patients＇ subjective initiative to improve their self-management skills and further promote their self -efficacy and psychological status. It is worthwhile to be popularized clinically. Key words： health self-management; diabetic foot ; self-efficacy; psychology; cold foot ; blood sugar