基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病患儿长期携带胰岛素泵治疗中的应用

doi:10.3760/cma.j.issn.1007-1245.2022.22.021

摘要/Abstract

摘要： 目的　探讨基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病（T1DM）患儿长期携带胰岛素泵治疗中的应用价值。方法　纳入2020年3月至2022年3月郑州大学附属儿童医院内分泌遗传代谢科门诊收治的学龄前期T1DM患儿86例开展前瞻性研究，其中男38例，女48例，年龄（4.71±0.73）岁。根据随机数字表法，分成循证组与常规组各43例。循证组采用基于循证医学的生活方式赋权综合管理，常规组采用常规管理方法。比较两组患儿管理前后糖化血红蛋白（HbA1c）及空腹血糖（FPG）、餐后2 h血糖（2hPG）水平，记录不良事件发生率。经心理弹性量表（CD-RISC）评估患儿照顾者心理状态的变化，分析照顾者对T1DM相关知识的了解程度，采用满意度问卷评估照顾者的满意度。采用χ²检验、秩和检验、t检验。结果　循证组管理3个月后FPG、2hPG、HbA1c分别为（6.34±0.41）mmol/L、（10.97±1.65）mmol/L、（6.42±0.51）mmol/L，低于常规组的（8.19±0.86）mmol/L、（13.64±1.70）mmol/L、（7.91±0.43）mmol/L（t=12.733、7.390、14.647，均P<0.001）。循证组患儿不良事件发生率为4.65%（2/43），低于常规组的18.60%（8/43）（χ²=4.074，P=0.044）。循证组管理3个月后CD-RISC评分为（88.11±8.55）分，高于常规组的（70.93±6.95）分（t=10.224，P<0.001）。循证组管理3个月后T1DM认知问卷评分为（30.82±2.50）分，高于常规组的（23.81±1.98）分（P<0.05）。循证组照顾者满意率为95.35%（41/43），高于常规组的79.07%（34/43）（χ²=5.108，P=0.024）。结论　基于循证医学的生活方式赋权综合管理能进一步对学龄前期T1DM患儿血糖进行控制，减少不良事件发生，并提高照顾者对疾病的了解程度与满意度。

关键词: 1型糖尿病, 学龄前期, 循证医学, 综合管理, 胰岛素泵

Abstract: Objective　To explore the value of evidence-based medicine based lifestyle empowerment integrated management in long-term insulin pump treatment for preschool children with type 1 diabetes mellitus (T1DM). Methods　A prospective study was conducted on 86 preschool children with T1DM who were admitted to the Department of Endocrinology, Genetics and Metabolism, Children 's Hospital Affiliated to Zhengzhou University from March 2020 to March 2022, including 38 males and 48 females, with an age of (4.71±0.73) years old. They are divided into an evidence-based group and a routine group according to the random number table method, with 43 cases in each group. The evidence-based group used evidence-based medicine based lifestyle empowerment integrated management, and the routine group used conventional management methods. The levels of glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2 hours' postprandial plasma glucose (2hPG) were compared between the two groups before and after management, and the incidence of adverse events was recorded. The Connor-Davidson Resilience Scale (CD-RISC) scale was used to evaluate the changes of the psychological state among the caregivers, the caregivers' understanding on T1DM was analyzed, and the satisfaction questionnaire was used to evaluate the caregivers' satisfaction. χ² test, rank sum test, and t test were used. Results　The FPG, 2hPG, and HbA1c in the evidence-based group were (6.34±0.41) mmol/L, (10.97±1.65) mmol/L, and (6.42±0.51) mmol/L after 3 months of management, which were lower than those in the routine group [(8.19±0.86) mmol/L, (13.64±1.70) mmol/L, and (7.91±0.43) mmol/L] (t=12.733, 7.390, and 14.647; all P<0.001). The incidence of adverse events in the evidence-based group [4.65% (2/43)] was lower than that in the routine group [18.60% (8/43)] (χ²=4.074, P=0.044). After 3 months of management, the CD-RISC score of the evidence-based group was (88.11±8.55), which was higher than that of the routine group (70.93±6.95) (t=10.224, P<0.001). The T1DM cognitive questionnaire score of the evidence-based group was (30.82±2.50) after 3 months of management, which was higher than that of the routine group (23.81±1.98) (P<0.05). The caregivers’ satisfaction rate in the evidence-based group was 95.35% (41/43), which was higher than that in the routine group [79.07% (34/43)] (χ²=5.108, P=0.024). Conclusion　Evidence-based medicine based lifestyle empowerment integrated management can further control the blood glucose in pre-school T1DM children, reduce the adverse events, and improve caregivers' understanding on the disease and satisfaction.

Key words: Type 1 diabetes mellitus, Preschool age, Evidence-based medicine, Integrated management, Insulin pump

刘玉皎王秋丽朱冬梅. 基于循证医学的生活方式赋权综合管理在学龄前期1型糖尿病患儿长期携带胰岛素泵治疗中的应用[J]. 国际医药卫生导报, 2022, 28(22): 3202-3207.

Liu Yujiao, Wang Qiuli, Zhu Dongmei. Application of evidence-based medicine based lifestyle empowerment integrated management in long-term insulin pump treatment for preschool children with type 1 diabetes mellitus[J]. International Medicine and Health Guidance News, 2022, 28(22): 3202-3207.

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