2型糖尿病胃转流术后患者生活方式转变应对策略的质性研究

Coping strategies for lifestyle changes in patients with type 2 diabetes mellitus after gastric bypass:a qualitative study

目的探索2型糖尿病(type 2 diabetes mellitus,T2DM)胃转流术后患者生活方式转变过程中的问题及应对策略。方法采用质性研究法,利用半结构式访谈法对15例T2DM胃转流术后患者进行深入访谈,并通过类属分析法对资料进行分析。结果术后患者生活方式转变中主要问题:包括饮食知识掌握不足、运动治疗严重缺乏、负性情绪逐渐增多以及患者随诊意愿不强和胃转流术后随访体系尚不健全。主要应对策略:包括提前计算饮食热量以量化饮食摄入、充分调动主观能动性,积极激励自我、多方面探索获取知识的途径以及术前及时改正不良生活方式行为习惯。影响患者生活方式转变因素:包括手术效果、亲友支持和角色转变。结论科学正确的生活方式是保证T2DM患者胃转流术治疗效果和避免远期并发症发生的重要手段。医护人员应加强关注术后患者生活方式管理问题,综合提高外科T2DM患者术后整体护理质量。

Objective To explore the problems and countermeasures of lifestyle changes in patients with type 2 diabetes mellitus（T2DM） after gastric bypass. Methods The qualitative research method was adopted,and semistructured interviews were used to interview 15 patients with T2DM after gastric bypass. Data were analyzed by the method of category analysis. Results Main issues of management of lifestyle in patients with T2DM after gastric bypass mainly focused on inadequate mastery of postoperative diet knowledge,severe lack of exercise therapy ,progressive increase of negative emotions,poor follow-up of patients and incomplete medical follow-up system. Patients with better management of lifestyle changes would calculate dietary calories in advance to quantify intake ,fully mobilize subjective initiative,actively motivate themselves,explore access to knowledge from multiple ways,and adjust lifestyle and form good habits before operation as main strategies. The practice of affecting lifestyle changes of pa- tients was mainly related to post-operative effects,support from relatives and friends,and ability to adapt to change of roles as soon as possible. Conclusion Scientific and correct lifestyles are important measures to ensure the ef- fects of gastric bypass and avoid long-term complications for patients with T2DM. Doctors and nurses should pay more attention to the problems,experience and coping strategies of postoperative patients in the process of lifestyle changes,so as to improve the overall nursing quality for patients with T2DM after surgery.