基础胰岛素临床规范化使用延续护理管理

Nursing management of continuation of basic insulin clinical standardization

目的探讨通过电话随访、微信、患者管理APP等以移动网络为媒介的远程护理管理模式对出院患者规范化使用基础胰岛素的效果。方法将2016年10月～2018年3月我院内分泌科住院使用基础胰岛素治疗的200例2型糖尿病患者,出院后在门诊根据随机数字表法分为干预组和对照组,每组100例,干预组采取"医-护-患"三人行一体化管理模式,通过电话随访、微信平台、患者血糖管理APP等方式,追踪患者血糖及基础胰岛素剂量数据,同时对患者进行为期3个月的糖尿病教育、指导及管理,对照组采取常规护理管理模式(常规宣教、患者自我监测血糖及门诊调整胰岛素),两组均随访管理3个月。结果干预组患者FBG、2hPBG、HbA1C、基础胰岛素剂量均低于对照组患者,数据差异有统计学意义(P <0.05);干预组患者正确掌握有关胰岛素均高于对照组患者,数据差异有统计学意义(P <0.05);干预组患者低血糖发生率2.0%,对照组患者低血糖发生率9.0%,数据差异有统计学意义(P <0.05);干预前两组患者DMQLS评分差异无统计学意义(P> 0.05);干预后对照组患者DMQLS评分低于干预组患者(P <0.05)。结论通过电话随访、微信平台、患者血糖管理APP等以移动网络为媒介的远程护理管理模式在2型糖尿病患者管理中是切实可行的,其效果明显,有效提高患者遵医性及用药依从性,从而从使患者血糖达标,值得临床推广。

Objective To explore the effect of remote nursing management mode on clinical standardization of basic insulin in discharged patients through telephone follow-up, WeChat, patient management APP and other mobile network. Methods Two hundred patients with type 2 diabetes were selected, who were treated with basic insulin in our hospital fi＇om October 2016 to March 2018. After discharge, they were divided into intervention group and control group by random number table method, with 100 eases in each group. The intervention group was given a ＂doctor-nurse-patient＂ three- person integrated management model. The blood sugar and basic insulin dosage data were tracked through telephone follow- up, Wechat platform, blood sugar management APP and other methods. At the same time, diabetes patients were educated. The control group was given routine nursing management mode（routine education, patient self-monitoring blood sugar and outpatient insulin adjustment）. Two groups were followed up for 3 months. Results FBG, 2hPBG, HbA1C and the basal insulin dose in intervention group were lower than those in control group, and the differences were slatistieally signifieant（P 〈 0.05）. The eolreet mastery of insulin in the intervention group was higher than that in the control group, and the difference was statistically significant（P 〈 0.05）. The incidence of hypoglycemia in the intervention group was 2.0%, which was significantly lower than that in the control group of 9.0%（P 〈 0.05）. There was no difference in DMQLS score between the two groups before intervention（P 〉 0.05）. After intervention, the DMQLS score of the control group was lower than that of the intervention group（P 〈 0.05）. Conclusion It is feasible to manage patients with type 2 diabetes mellitus through remote nursing management mode such as telephone follow-up, Weehat platform, blood sugar management APP and so on, which is mediated by mobile network. Its effect is obvious, and it can effectively improve patients＇compliance with medicine and medication compliance, so as to make blood sugar meet the standard, and it is worthy of clinical promotion.