王志忠等

[摘要] 目的 探讨路径化管理对社区糖尿病患者治疗依从性及治疗效果的影响，为社区有效管理糖尿病提供科学的方法。 方法 180例2型糖尿病患者随机分为观察组与对照组，各90例。观察组：在常规门诊的基础，对患者进行路径化管理1年；对照组：对患者实行常规门诊管理1年。比较两组管理效果。 结果 观察组的依从性优良率，由58.89%升至91.11%，对照组的依从性优良率从56.67%升至66.67%，两组依从性优良率提高幅度比较，差异有统计学意义（P < 0.05）。观察组依从性差的患者比例由41.11%降至8.89%，对照组依从性差的患者比例由44.44%降至34.44%，两组比较，差异有统计学意义（P < 0.05）。观察组干预后空腹血糖为（6.11±1.34）mmol/L，餐后2 h血糖为（7.46±1.89）mmol/L，糖化血红蛋白为（6.24±0.90）%；对照组干预后空腹血糖为（7.52±2.01）mmol/L，餐后2 h血糖为（8.93±2.84）mmol/L，糖化血红蛋白为（7.18±0.95）%，两组比较，差异有统计学意义（P < 0.05）。同时，路径管理加强了患者自我管理能力和医患关系的和谐稳定。 结论 路径化管理对社区糖尿病患者的治疗依从性及治疗效果有明显影响，是提高糖尿病干预效果的科学方法。

[关键词] 社区；糖尿病；管理；路径；依从性

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-7210（2014）09（c）-0048-06

Effect of path management on community diabetes treatment compliance and its therapeutic effect analysis

WANG Zhizhong WANG Yaping YANG Bin WANG Jing HU Yenuan

Diabetes Intervention Group of the Third Outpatient Department， Beijing Military General Hospital， Beijing 100700， China

[Abstract] Objective To explore the effect of path management on treatment compliance and treatment outcome of community diabetic patients and to provide scientific method for the community effective management of diabetes. Methods 180 patients with type 2 diabetes were randomly divided into the observation group and the control group， each group had 90 cases. Observation group was given one year path management， on the basis of conventional outpatient； control group was given one year the conventional outpatient management. The management effects were compared between the two groups. Results The rate of excellent compliance had risen from 58.89% to 91.11% in the observation group， which had risen from 56.67% to 66.67% in the control group， the rate of excellent compliance was compared between the two group， the difference was statistically significant （P < 0.05）. The rate of poor compliance had fallen from 41.11% to 8.89% in the observation group， which had fallen from 44.44% to 34.44% in the control group； the rate of poor compliance was compared between the two group， the difference was statistically significant （P < 0.05）. After the intervention in the observation group， fasting glucose was （6.11±1.34） mmol/L， 2 h postprandial blood glucose was （7.46±1.89） mmol/L， glycosylated hemoglobin was （6.24±0.90）%； after intervention in the control group， fasting glucose was （7.52±2.01） mmol/L， 2 h postprandial blood glucose was （8.93±2.84） mmol/L， glycosylated hemoglobin was （7.18±0.95） %， which were compared between the two groups， the differences were statistically significant （P < 0.05）. Meanwhile， the path management had strengthened the patients self-management ability and the doctor-patient relationship harmony and stability. Conclusion Path management has significant effect on the treatment compliance and treatment outcome for community diabetes patients， and it is a scientific method for improvement of diabetes intervention effect.

[Key words] Community； Diabetes； Management； Path； Compliance

糖尿病是一组以慢性血糖水平升高为特征的代谢性疾病。根据国际糖尿病联盟（International Diabetes Federation，IDF）统计，目前全球糖尿病患者已达2.85亿，我国成人糖尿病患者总数达9240万。按目前的增长速度，估计到2030年全球将有近5亿人患糖尿病[1]。糖尿病给患者、家庭和社会造成的危害来自于糖尿病的急、慢性并发症，严重地威胁着患者的健康甚至生命，导致医疗费用急剧增长，给个人、家庭和社会带来了沉重的负担。世界卫生组织评估2005～2015年中国由于糖尿病及相关心血管疾病导致的经济损失达5577亿美元[2]。糖尿病已经成为严重威胁我国人群健康的公共卫生问题，同时也是社区医生必须经常面对与处理的常见病之一[3]。糖尿病一经确诊往往需要长期治疗，需要患者具有良好的依从性，才能有效控制血糖水平，减少或避免急慢性并发症的发生[4]。但是由于多种因素的影响，患者的依从性比较差[5-6]。……