方圆 龚为真 薛平

摘 要 目的：研究“七步洗手法”改善女性2型糖尿病患者前臂遠端骨密度的作用。方法：选取本社区管理的女性2型糖尿病患者102例，随机分为观察组和对照组，每组51人。观察组平均年龄为（69.80±3.19）岁，对照组平均年龄为（69.84±3.35）岁。两组均给予均衡饮食指导及碳酸钙D3片，对观察组患者另外给予“七步洗手法”腕关节锻炼。比较干预12个月后两组对象桡骨远端1/3骨密度的差异。结果：干预后观察组和对照组的桡骨远端1/3骨密度中位数均高于干预前，差异均有统计学意义（0.333 g/m2比0.321 g/m2，P<0.001；0.322 g/m2比0.319 g/m2，P<0.01），但观察组的桡骨远端1/3骨密度中位数高于对照组，差异有统计学意义（P<0.001）。结论：“七步洗手法”步骤涵盖了腕关节全部活动功能的锻炼，又附带一定的抗阻和振动运动模式，可以有效提高前臂远端骨密度。该法简便易用，依从性好，适宜在社区推广应用。

关键词 2型糖尿病；七步洗手法；前臂远端；骨密度

中图分类号：R587.1 文献标志码：A 文章编号：1006-1533（2020）16-0054-03

Effect of “seven-step hand-washing method” in the improvement of bone mineral density of distal forearm in female patients with type 2 diabetes mellitus

FANG Yuan1， GONG Weizhen2， XUE Ping2（1.Department of General Medicine of Jiangwan Community Health Service Centre of Hongkou District， Shanghai 200434， China；2. Department of Nursing of Jiangwan Community Health Service Centre of Hongkou District， Shanghai 200434， China）

ABSTRACT Objective： To study the effect of “seven-step hand-washing method” in the improvement of bone mineral density（ BMD） of distal forearm in female patients with type 2 diabetes mellitus（ T2DM） . Methods： One hundred and two female patients with T2DM under community management were selected and randomly divided into an observation group and a control group with 51 cases in each group. The average age of the observation group was （69.80±3.19） years， and the average age of the control group was （69.84±3.35） years. Both groups were given a balanced diet and calcium carbonate D3 tablet， and the observation group was also given “seven-step hand-washing method” wrist exercise. The BMD difference of 1/3 of the distal radius between the two groups was compared after 12 months of intervention. Results： The median BMD of 1/3 of the distal radius of the observation group and the control group were higher after the intervention than before the intervention， and the differences were statistically significant （0.333 g/m2 vs. 0.321g/m2， P<0.001； 0.322 g/m2 vs. 0.319 g/m2， P<0.05）. The median BMD of 1/3 of the distal radius of the observation group was higher than that of the control group after intervention， and the difference was statistically significant（P<0.001）. Conclusion： The “ seven-step hand-washing method “ covers the exercise of all motion functions of the wrist joint， with certain anti-resistance and vibration movement modes， and can effectively improve the BMD of distal forearm. The method is simple and easy to use， has good compliance， and is suitable for promotion and application in the community.

KEY WORDS type 2 diabetes mellitus； seven-step hand-washing method； distal forearm； bone mineral density

2型糖尿病（T2DM）是骨质疏松症的高危人群。糖代谢与骨代谢之间的多种藕联机制使得T2DM患者骨量持续丢失，发生骨质疏松性骨折的风险明显高于非糖尿病人群[1]。骨质疏松性骨折的易发部位包括中轴骨的椎体和髋部以及四肢骨的肱骨近端和前臂远端[2]。运动疗法是维持和提高骨量，降低骨质疏松性骨折风险的有效方法。但临床实践中适用于老年骨质疏松症患者的非阻抗性运动疗法（包括八段锦、太极拳为代表的传统功法和以慢跑、骑自行车为代表的现代康复训练）主要以锻炼承重的椎体、髋关节以及肩关节等为主[3]，前臂远端與腕关节的针对性锻炼方法应用较少。而手卫生技术规范中的常用技术“七步洗手法”可通过腕关节的运动，对前臂远端施加一定的抗阻力及高频振动，对改善局部骨密度有益。……