陕西省人民医院2型糖尿病患者中医临床证型分布特点及辨证施护效果分析

Analysis of the Distribution Characteristics of TCM Clinical Syndromes and the Effect of Dialectical Nursing in Patients with Type 2 Diabetes Mellitus in Shaanxi Provincial People's Hospital

目的:调查陕西省人民医院2型糖尿病(T2DM)患者中医临床证型分布特点,并观察对T2DM患者进行辨证施护的效果。方法:选取2018年6月至2020年12月陕西省人民医院收治的481例T2DM患者为调查对象,通过医疗信息管理系统收集患者临床资料,根据辨证分型标准对其进行辨证分型,统计中医临床证型分布特点。将上述患者随机分为对照组(240例,行常规护理)和研究组(241例,行辨证施护)。观察两组患者护理前后血糖水平、自我管理能力及患者生活质量。结果:陕西省人民医院T2DM患者中医临床证型依次为气阴两虚证31.60%(152/481)、阴虚燥热证28.48%(137/481)、痰瘀阻络证18.09%(87/481)、肝郁气滞证12.27%(59/481)、阴阳两虚证9.56%(46/481);各证型的出现频率随着年龄的增长而升高,在青年患者中阴虚燥热证的发生频率较高,在中年患者与老年患者中气阴两虚证发生频率较高;在不同病程组中,气阴两虚证与阴虚燥热证的发生频率较高,随着病程的延长,阴阳两虚证、痰瘀阻络证、气阴两虚证的发生频率呈上升趋势,阴虚燥热证、肝郁气滞证呈下降趋势。护理后,两组同种证型患者糖化血红蛋白(HbA1c)水平差比较,差异无统计学意义(P>0.05),研究组中阴阳两虚证、阴虚燥热证、痰瘀阻络证、肝郁气滞证、气阴两虚证患者的空腹血溏(FPG)水平均低于对照组中的同种证型(P<0.05),研究组中阴阳两虚证、阴虚燥热证、痰瘀阻络证、肝郁气滞证、气阴两虚证患者的成年人健康自我管理能力量表(AHSMSRS)、世界卫生组织生存质量测定量表(WHO-QOL-BREF)评分均高于对照组中的同种证型(P<0.05)。结论:陕西省人民医院T2DM患者以气阴两虚证、阴虚燥热证较为常见,不同证型的分布与患者的年龄、病程存在一定的联系,对不同证型的T2DM患者采取针对性护理,有利于改善患者的血糖水平,提高患者自我管理能力及生活质量。

Objective:To investigate the distribution characteristics of TCM clinical syndromes in patients with type 2 diabetes mellitus(T2DM)in Shaanxi Provincial People's Hospital,and to observe the effect of dialectical nursing for T2DM patients.Methods:A total of 481 patients with T2DM admitted to Shaanxi Provincial People's Hospital from June 2018 to December 2020 were selected as the survey objects.The clinical data of patients were collected through the medical information management system.According to the standard of syndrome differentiation,syndrome differentiation was carried out,and the distribution characteristics of clinical symptoms of TCM were counted.The above patients were randomly divided into control group(240 cases,routine nursing)and study group(241 cases,dialectical nursing).The blood glucose level,self-management ability and quality of life of the two groups before and after nursing were observed.Results:The T2DM patients in Shaanxi Provincial People's Hospital were classified as 31.60%(152/481)of Qi and Yin deficiency syndrome,28.48%(137/481)of Yin deficiency and dryness-heat syndrome,18.09%(87/481)of phlegm and blood stasis syndrome,12.27%(59/481)of liver Qi stagnation syndrome,and 9.56%(46/481)of Yin and Yang deficiency syndrome.The frequency of occurrence of each syndrome type increases with age.The frequency of Yin deficiency and dryness-heat syndrome is higher in young patients,and the occurrence frequency of Qi and Yin deficiency syndrome is higher in middle-aged and elderly patients.In different disease course groups,the frequency of Qi and Yin deficiency syndrome and Yin deficiency and dryness-heat syndrome are more frequent.With the extension of the course of disease,the occurrence frequency of Yin and Yang deficiency syndrome,phlegm and blood stasis syndrome,and Qi and Yin deficiency syndrome showed an upward trend,while that of Yin deficiency and dryness-heat syndrome and liver Qi stagnation syndrome showed a downward trend.After nursing,there was no significant difference in HbA1c level between the two groups of patients with the same syndrome type(P>0.05).The FPG levels of patients with Yin and Yang deficiency syndrome,Yin deficiency and dryness-heat syndrome,phlegm and blood stasis syndrome,liver Qi stagnation syndrome,and Qi and Yin deficiency syndrome in the study group were lower than those in the control group(P<0.05).The AHSMSRS and WHO-QOL-BREF scores of patients with Yin and Yang deficiency syndrome,Yin deficiency and dryness-heat syndrome,phlegm and blood stasis syndrome,liver Qi stagnation syndrome,and Qi and Yin deficiency syndrome in the study group were higher than those in the control group(P<0.05).Conclusion:T2DM patients in Shaanxi Provincial People's Hospital are more common with Qi and Yin deficiency syndrome and Yin deficiency and dryness-heat syndrome.The distribution of different syndrome types is related to the age and course of the disease.Targeted nursing should be taken for T2DM patients with different syndrome types.It is beneficial to improve the blood sugar level of patients,improve the self-management ability and quality of life of patients.