住院糖尿病患者低血糖标准化护理管理模式的构建与研究

Construction and study of standardized nursing management model for hypoglycemia in diabetic inpatients

目的构建住院糖尿病患者低血糖标准化护理管理模式,并观察其应用效果。方法采用整群抽样法,选取2017年1—12月于郑州人民医院住院的9251例糖尿病患者作为对照组,选取2018年1—12月于郑州人民医院住院的9636例糖尿病患者作为观察组。对照组给予常规护理和血糖管理。2018年,结合全院血糖监测系统,通过成立糖尿病教育管理学组,制订低血糖标准化护理管理流程,并行全院培训,提高全院护士低血糖处理水平。观察组应用低血糖标准化护理管理模式进行护理和血糖管理。比较两组的低血糖发生率、血糖波动情况及实施前后护士低血糖知识掌握情况。结果观察组低血糖发生率低于对照组[7.51%(724/9636)vs.18.30%(1693/9251)],两组比较差异有统计学意义(χ^2=492.7,P<0.001)。观察组平均血糖值(GluAve)、日内平均血糖波动幅度(MAGE)、血糖不稳定指数(GLI)及血糖变异率(GluCV)均低于对照组,差异均有统计学意义(t值分别为-18.121、-53.788、-34.362、-61.794;P<0.01)。2018年低血糖标准化护理管理模式实施后,护士低血糖相关知识掌握问卷5个维度评分及总分均高于2017年低血糖标准化护理流程实施前(t值分别为15.439、66.542、73.320、14.565、36.101、34.664;P<0.01)。结论低血糖标准化护理管理模式可以降低低血糖发生率,减少患者血糖波动幅度,提高护士对低血糖知识的掌握水平,使患者的血糖控制更安全。

Objective To establish a standardized nursing management model for hypoglycemia in diabetic inpatients and observe its application effects.Methods Totally 9251 diabetic patients hospitalized in People's Hospital of Zhengzhou between January and December 2017 were selected into the control group,while another 9636 diabetic patients hospitalized in People's Hospital of Zhengzhou between January and December 2018 were selected into the observation group by cluster sampling.Patients in the control group received routine care and glycemic management.In 2018,in conjunction with the glycemic monitoring system,we established a diabetes education management team and developed a standardized nursing management process for hypoglycemia,which was promoted throughout the hospital to improve the level of hypoglycemic control among nurses throughout the hospital.Patients in the observation group received care and glycemic control using the standardized nursing management model for hypoglycemia and glycemic control.The incidence of hypoglycemia,glycemic fluctuations,and nurses'knowledge of hypoglycemia before and after implementation were compared between the two groups.Results The incidence of hypoglycemia in the observation group was lower than that in the control group[7.51%(724/9636)vs.18.30%(1693/9251)],and the difference was statistically significant(χ^2=492.7,P<0.001).The observation group's average blood glucose value(GluAve),daily mean amplitude of glycemic excursions(MAGE),glycemic instability index(GLI),and glycemic coefficient of variation(GluCV)were all lower than the control group,and the differences were statistically significant(t=-18.121,-53.788,-34.362,-61.794;P<0.01).After the implementation of the standardized management model for hypoglycemia in 2018,the total score dimensional scores of the nurses'knowledge about hypoglycemia were higher than those before the implementation of the standardized nursing process for hypoglycemia in 2017,and the differences were all statistically(t=15.439,66.542,73.320,14.565,36.101,34.664;P<0.01).Conclusions The standardized nursing management model for hypoglycemia can reduce the incidence of hypoglycemia as well as fluctuations of the patients,improve the level of nurses'knowledge of hypoglycemia,and make the patients'glycemic control safer.