闭合式护理管理模式对初发2型糖尿病患者PWV和ABI的影响

Influence of closed nursing management mode on PWV and ABI in patients with newly diagnosed type 2 diabetes mellitus

目的 探讨护理干预对初发2型糖尿病患者肱踝脉搏波传导速率（PWV）和踝臂指数（ABI）的影响.方法 选取80例初发2型糖尿病患者,分为干预组和对照组各40例,干预组采用闭合式综合护理管理模式进行干预,即建立小组健康档案,采用慢病护理管理小组模式,选择经过专科培训的相关资质专科医生、慢病专科护士、全科护士组建慢病管理团队,整个团队对患者展开院内、院外的疾病诊治、心理干预和日常生活（膳食、运动等）指导等;院外包括：每周电话随访,每月规律家访及指导,每3个月复查相关预设指标.所有入选慢病管理团队者均进行岗前培训,充分了解本人在本团队中的职责、义务、工作内容等,并签署团队责任书.对照组采用传统常规糖尿病护理管理模式进行干预.经过2年的干预,对比观察两组患者动脉硬化早期血液检测指标（PWV和ABI）数值的变化.结果 干预前,两组患者PWV和ABI差异均无统计学意义（P〉0.05）.干预后,干预组PWV为（1552±462）cw/s,对照组为（1613±417）cw/s,差异有统计学意义（t=2.031,P=0.047）,且干预组组内干预前后差异有统计学意义（t=2.533,P=0.008）.干预后,ABI水平虽也有改善,但干预组与对照组、干预组组内差异均无统计学意义（P〉0.05）.结论 闭合式护理管理模式可改善初发2型糖尿病患者PWV,延缓动脉硬化的进展.

Objective To investigate the influence of the nursing intervention on the ankle-brachial pulse wave velocity （PWV） and the ankle-brachial index （ABI） in patients with newly diagnosed type 2 diabetes mellitus. Methods Eighty patients with newly-diagnosed type 2 diabetes mellitus were selected and were completely randomly divided into the intervention group （40 patients） and the control group （40 patients）. In the intervention group, the closed integrated nursing management mode was applied. Group health records were established and the nursing management group mode of chronic diseases was applied. The chronic disease management team was organized with specialist physicians, chronic disease specialist nurses and general practice nurses who were specialized trained and got related qualification. The whole team diagnosed patients in hospital and out of hospital, gave mental intervention and daily life guidance to patients （diet, sports and so on）. Outside of hospital, the telephone follow-up was made every week; the regular family visit was made and the guidance was given to patients every month; the related presupposed indicators were tested every three months. All the patients who were enrolled in the chronic disease management team were given the pre-job training to fully understand their responsibilities, obligations, work contents, etc. in the team. They also signed the team＇s responsibility statement. In the control group the traditional diabetes nursing management mode was used. After two years intervention, the early detection atherosclerosis blood indexes （PWV and ABI） of patients in the two groups were compared. Results Before the intervention, there was no significant difference in the PWV or the ABI between the two groups （P〉 0.05）. After the intervention, the PWV in the intervention group was （1 552±462）cw/s, which was significantly different compared with that in the control group（1 613±417）cw/s （t=2.031, P=0.047）. Moreover, in the intervention group, the PWV before the intervention was significantly different compared to the PWV after the intervention（t=2.533,P=0.008）. After the intervention, the ABI was improved, but the ABI in the intervention group was not significantly different compared with that in the control group. In the intervention group, the ABI before the intervention was not significantly different from that after the intervention（P〉0.05）. Conclusions The closed nursing management mode can improve the PWV value in patients with newly diagnosed type 2 diabetes mellitus and delay the development of atherosclerosis.