卢丽丽 廖米荣

[摘要] 目的 探讨认知行为干预对糖尿病患者治疗依从性、血糖达标及认知功能的影响。 方法 选取2016年7月～2017年8月就诊的糖尿病患者70例，随机分为观察组和对照组。两组均予以甘精胰岛素+阿卡波糖联合控制血糖治疗。对照组予以常规干预，观察组在对照组基础上加用认知行为干预，两组均干预3个月。观察并比较两组干预前后依从性、血糖达标和认知功能变化。 结果 干预3个月后，观察组治疗总依从性率高于对照组（χ2=4.20，P<0.05）；观察组空腹血糖（FBG）、餐后2 h血糖（2 hPG）和糖化血紅蛋白（HbA1c）达标率高于对照组（P<0.05）；同时两组简明精神状态量表评分（MMSE）与洛文斯顿成套测验量表评分（LOTCA）较前均不同程度上升（P<0.05或P<0.01），且观察组上升幅度较对照组更显著（P<0.05）。 结论 糖尿病患者予以认知行为干预的效果肯定，不仅可提高治疗依从性，加快血糖达标，而且可延缓认知功能下降的幅度，改善其认知功能。

[关键词] 糖尿病；认知行为干预；治疗依从性；认知功能

[中图分类号] R473.5；R587.1 [文献标识码] B [文章编号] 1673-9701（2018）24-0147-04

[Abstract] Objective To explore the effect of cognitive behavior intervention on therapy compliance， blood glucose control and cognitive function in treatment of patients with diabetes mellitus. Methods A total of 70 patients with diabetes mellitus who were treated from July 2016 to August 2017 were selected and randomly divided into control group and observation group. Both groups received insulin glargine plus acarbose treatment to control blood glucose level. The patients in control group were treated with regular treatment. The observation group added cognitive behavior intervention on the basis of control group. The course took 3 months for each group. The therapy compliance， blood glucose control and cognitive function of each group before and after treatment were observed and compared. Results After 3 months of intervention， the total therapy compliance of the observation group was higher than that of the control group （χ2=4.20， P<0.05）. The reaching rates of fasting blood glucose （FBG）， postprandial 2 h blood glucose （2 hPG） and glycosylated hemoglobin （HbA1c） in the observation group were higher than those in the control group（P<0.05）. Meanwhile， the Minimum Mental State Examination（MMSE） scores and Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） scores of both groups increased to varying degrees after treatment（P<0.05 or P<0.01）， and the increase of the observation group was more significant than that of the control group（P<0.05）. Conclusion The cognitive behavior intervention in treatment of patients with diabetes mellitus has certain effect， which not only can improve therapy compliance and accelerate the speed of reaching target level of blood glucose， but also can delay the decrease of cognitive function， improving cognitive function.

[Key words] Diabetes mellitus； Cognitive behavior intervention； Therapy compliance； Cognitive function

糖尿病是中老年患者常见的慢性疾病，其病因主要是胰岛素的分泌功能下降导致慢性糖代谢紊乱。糖尿病患者的糖代谢异常可损害中枢神经系统，加速大脑组织的退化，引起认知功能的障碍[1，2]。糖尿病作为一种终身性疾病，其病程漫长，难以治愈，患者常对治疗失去信心，导致其治疗依从性下降，血糖控制难以达标，并发症居高不下，也增加了认识功能障碍的发生率[3，4]。目前，对糖尿病患者的干预措施主要集中在血糖控制达标方面，而对糖尿病引起的认知功能障碍干预较少[5，6]。认知行为干预是通过改变思维或信念和行为的方法改变不良或错误认知的干预方法，近年来逐渐应用于临床中，但其在糖尿病患者干预中的作用鲜有报道[7，8]。本研究观察了糖尿病患者予以认知行为干预后治疗依从性、血糖达标及认知功能的变化，现报道如下。……