糖尿病患者低血糖感知受损的概念分析

Impaired awareness of hypoglycemia: a conceptual analysis

目的探讨糖尿病患者低血糖感知受损概念的定义及其内涵,为指导医护人员的临床实践以及相关研究提供参考。方法检索中国知网、万方数据、Web of Science、PubMed、EMbase等数据库中低血糖感知受损的相关文献,采用Walker和Avant概念分析模型进行低血糖感知受损的概念分析。结果共纳入35篇文献,低血糖感知受损定义属性为接受胰岛素治疗的糖尿病患者、反复暴露于低血糖和感知低血糖能力减弱或消失;前置因素为一般人口学因素、低血糖史、严格的血糖控制以及焦虑恐惧等心理因素;后果为认知功能损害、心血管事件风险增加以及心理社会负担;评估工具有Gold分数法、Clarke量表、Pedersen问卷及低血糖意识问卷。结论通过低血糖感知受损的概念分析,正确理解、预防、识别低血糖感知受损,有助于为今后低血糖感知受损相关研究提供参考。

Objective To explore the concept of impaired hypoglycemic awareness in patients with diabetes mellitus and to provide theoretical basis for guiding clinical practice of medical staff and related research.Methods Publications related to impaired awareness of hypoglycemia were searched from CNKI, Wanfang Database, Web of Science, PubMed and EMbase, and Walker and Avant concept analysis method was used to analyze the concept of impaired awareness of hypoglycemia.Results A total of 35 publications were included.The defining attributes of impaired awareness of hypoglycemia were diabetic patients receiving insulin therapy, repeated exposure to hypoglycemia and decreased or vanishing awareness of hypoglycemia.The antecedents were general demographic factors, history of hypoglycemia, strict blood glucose control, anxiety and fear, etc.The outcomes were cognitive impairment, increased risk of cardiovascular events, and psychosocial burden.The concept was mainly assessed by the Gold Score, Clarke Scale, Pedersen Questionnaire and Hypoglycemia Awareness Questionnaire.Conclusion Concept analysis of impaired hypoglycemic awareness, enables correct understanding, prevention and cognition of the condition, which can provide reference for future research on impaired awareness of hypoglycemia.