2020 年第 7 期 第 15 卷

针对性健康指导干预对2型糖尿病合并急性脑梗死患者血糖水平及脑梗死预后的影响

Effects of targeted health instruction intervention on blood glucose level and prognosis of cerebral infarction in patients with type 2 diabetes mellitus complicated with acute cerebral infarction

作者：文丽娜1张晶晶1高嫚2周迎生1赵一楠1马立萍3陆祖谦4

英文作者：Wen Lina1 Zhang Jingjing1 Gao Man2 Zhou Yingsheng1 Zhao Yinan1 Ma Liping3 Lu Zuqian4

单位：1首都医科大学附属北京安贞医院内分泌代谢科100029；2首都医科大学附属北京安贞医院神经内科100029；3首都医科大学附属北京安贞医院全科医疗科100029；4战略支援部队特色医学中心内分泌科，北京100101

英文单位：1Department of Endocrinology and Metabolism Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 2Department of Neurology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 3Department of General Practice Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 4Department of Endocrinology Featured Medical Center of the Strategic Support Force Beijing 100101 China

关键词：2型糖尿病；脑梗死；针对性健康指导干预

英文关键词：Type2diabetesmellitus；Cerebralinfarction；Targetedhealthguidanceintervention

• 摘要：

• 目的探讨针对性健康指导干预对2型糖尿病合并急性脑梗死患者血糖水平及脑梗死预后的影响。方法选择2017年1月至2018 年12 月于首都医科大学附属北京安贞医院住院治疗的2型糖尿病伴急性脑梗死患者60 例作为研究对象。完全随机分为观察组和对照组，各30例。出院后，对照组给予常规指导；观察组在常规指导的基础上给予针对性健康指导干预，包括心理干预、个体差异化宣教、生活指导、饮食护理、人文支持；干预时间均为6个月。比较2组干预前后血糖水平，通过美国国立卫生研究院卒中量表（NIHSS）以及日常生活活动能力量表（ADL）评估脑梗死预后情况。结果干预后2组HbA1c、空腹血糖、餐后2 h血糖均较治疗前降低，且观察组低于对照组［（6.2±1.2）%比（7.1±1.9）%、（6.8±1.9）mmol/L比（8.2±2.6）mmol/L、（9.0±2.1）mmol/L比（10.2±3.0）mmol/L］，差异均有统计学意义(均P＜0.05)；2组均无低血糖发生。NIHSS评分分类结果显示，干预后观察组正常、轻度残疾比例高于对照组，中度残疾、重度残疾比例低于对照组，分类比例差异有统计学意义（χ2=8.190，P=0.042）。ADL评分分类结果显示，干预后观察组生活自理及基本自理的比例明显高于对照组，生活需要协助及完全依赖的比例低于对照组，分类比例差异有统计学意义（χ2=9.376，P=0.025）。结论通过针对性健康指导干预能显著改善血糖水平，同时能有效改善脑梗死患者的预后，提高生活质量。

• ObjectiveTo explore the effect of targeted health instruction intervention on blood glucose level and prognosis of cerebral infarction in patients with type 2 diabetes mellitus complicated with acute cerebral infarction. Methods Totally 60 patients in type 2 diabetes complicated with acute cerebral infarction were selected. They were completely randomly divided into control group and observation group, with 30 cases in each group. After discharge, the control group was given routine guidance； the observation group was given targeted health guidance intervention on the basis of routine guidance, including psychological intervention, individual differential education, life guidance, diet care and humanistic support； the intervention time was 6 months in both groups. Blood glucose levels were compared between the two groups before and after intervention. The prognosis of cerebral infarction was evaluated by national institute of health stroke scale(NIHSS) and activities of daily living scale(ADL). Results  After intervention, the glycated hemoglobin(HbA1C), fasting blood glucose and 2-h postprandial blood glucose in the two groups were lower than those before treatment, and in observation group were significantly lower than those in control group［（6.2±1.2）% vs （7.1±1.9）%, （6.8±1.9）mmol/L vs （8.2±2.6）mmol/L, （9.0±2.1）mmol/L vs （10.2±3.0）mmol/L］(all P<0.05). NIHSS score classification results   showed that after intervention the proportion of normal and mild disability in the observation group was higher than that in the control group, and the proportion of moderate and severe disability was lower than that in the control group (χ2=8.190，P=0.042). The results   of ADL score classification showed that after intervention the proportion of self-care and basic self-care in the observation group was significantly higher than that in the control group, and the proportion of life assistance and complete dependence was lower than that in the control group. The difference of classification proportion was statistically significant(χ2=9.376，P=0.025). Conclusion Through targeted health guidance intervention, the blood sugar level, prognosis and the quality of life of patients with cerebral infarction can be improved.