糖尿病综合治疗模式在高血压病病人管理中的应用

高血压是慢性终身性疾病,发病率高,与遗传、肥胖、膳食等因素有关,血压不能得以合理控制可引起严重的心、脑、肾并发症等。因此健康教育在高血压病病人的护理中显得尤为重要,而在高血压病人健康教育需求调查中,有79．1％的病人不能遵医嘱长期规律服药,66．4％病人不能自我监测和记录血压,5％左右病人仍未戒烟酒,疾病不能控制和治疗,     

健康教育在糖尿病病人治疗中的作用

糖尿病是一种终身性疾病，如果血糖长期处于高水平状态可导致心血管、肾脏、眼、神经等多种并发症的发生，甚至危及生命。传统的对糖尿病病人的治疗主要是进行药物治疗和饮食控制，较少对病人进行健康教育，使糖尿病病人对相关知识了解甚少，出院后血糖难以控制，病情发展较快。而现代治疗糖尿病的方法为健康教育、饮食控制、运动疗法、药物控制、自我监测等综合措施。医务人员为病人进行糖尿病知识教育，对于积极治疗和控制疾病的发展及并发症的发生，提高病人的生活质量有着重要意义。现将我科收住的30例初诊糖尿病病人且无并发症的病人进行了健康教育，结果介绍如下。     

知信行健康教育模式在老年高血压合并糖尿病病人中的应用

[目的]探讨知信行健康教育模式对老年高血压合并糖尿病病人的影响.[方法]将136例高血压合并糖尿病的老年病人采用随机数字表法分为观察组和对照组各68例,观察组实施以知信行健康教育模式为理论基础的护理干预,对照组实施常规的健康教育,在干预前和干预2个月后分别采用知信行问卷、日常生活活动能力量表、病人满意度调查表进行调查和测评,并将两组病人干预前后的血压、血糖指标控制情况及临床症状改善情况进行比较.[结果]观察组病人知信行水平、日常生活活动能力及病人的满意率、临床症状改善总有效率均明显高于对照组(P＜0.05),观察组病人的血压、血糖指标均明显改善,与对照组相比差异有统计学意义(P＜0.05).[结论]运用知信行健康教育模式进行护理干预能有效提高老年高血压合并糖尿病病人对自身疾病的正确认识,主动建立健康的行为及生活方式,提高治疗依从性和自我管理能力,促进疾病的恢复,提高病人的满意度.     

PDCA模式结合ABC管理方法在老年糖尿病病人健康教育中的应用

[目的]探讨PDCA模式结合ABC管理方法在老年糖尿病病人健康教育中的应用效果。[方法]将60例老年糖尿病病人随机分为研究组与对照组,研究组采取PDCA模式结合ABC管理方法对病人进行健康教育,对照组采取常规的健康教育方法。[结果]两组病人空腹血糖、餐后2h血糖及治疗的依从性差异有统计学意义(P<0.05或P<0.01)。[结论]在老年糖尿病病人健康教育中应用PDCA模式结合ABC管理方法可使病人的病情得到有效的控制,提高治疗依从性。     

改变就诊模式 综合治疗糖尿病

目的 本文简述了近几十年糖尿病的诊治发展情况。方法 提出了综合治疗糖尿病方案的重要性。如何就生活模式、饮食结构、疾病谱的变化通过综合治疗的过程，来改变我们多少年来的就诊模式，提出了糖尿病文化教育在全民开展的重要性。结果 达到提高糖尿病患者的生活质量，延长寿命的目的。结论 希望致力于糖尿病研究的医生共同协作，尽早研制开发出有效防治糖尿病的饮食及药物，防止糖尿病在全社会的发生发展。     

药护合作模式在糖尿病病人健康教育中的应用效果观察

[目的]探讨临床药师与护士合作健康教育模式在住院糖尿病病人中的应用效果。[方法]将96例病人随机分为两组,对照组实施传统的一般性健康教育,观察组采取药护合作健康教育模式,比较两组病人在出院时相关疾病知识掌握情况、对健康教育的满意度及出院时治疗依从性。[结果]健康教育后观察组病人疾病知识掌握情况、对健康教育的满意度及治疗依从性显著优于对照组。[结论]药护合作健康教育模式能提高健康教育效果、病人对健康教育的满意度以及病人的治疗依从性。     

健康教育在糖尿病病人中的应用

目的：对糖尿病病人进行健康教育是减少糖尿病急、慢性并发症和致死率的重要措施。方法：根据糖尿病病人的特点。对121例糖尿病病人进行入院宣教、心理指导、饮食指导、体育锻炼指导、胰岛素治疗指导、出院宣教等方面的健康教育。结果：121例病人不同程度掌握了疾病相关知识，增强了自我保健能力，降低并发症的发生率。结论：健康教育提高了病人的自我保健能力，减少并发症，提高了病人的生活质量。     

临床护理路径在糖尿病病人健康教育中的应用进展

糖尿病(DM)健康教育作为一种治疗手段已在临床上广泛应用,但尚无一种公认的、很好的健康教育模式。随着社会的发展,人们生活质量及认识水平的不断提高,对健康知识的需求也向更高层次转变[1],对健康教育的需求随之增加。随着医学的发展,临床护理路径(CNP)作为以病人为中心的成效     

高血压病人的门诊治疗体会

高血压是门诊最常见的心血管疾病 ,且目前尚无根治方法 ,必须长期甚至终身治疗。合理的治疗可以将血压控制在理想水平 ,全面降低心血管疾病的发病率和病死率。故高血压病人的门诊治疗极为重要。1　健康教育在健康体检及门诊日常工作中 ,我们感到部分高血压患者对身患高血压病缺     

聚焦解决模式在2型糖尿病病人自我管理中的应用

[目的]探讨聚焦解决模式教育对改善病人自我管理能力及客观指标的有效性。[方法]将门诊120例2型糖尿病病人随机分为两组,对照组给予常规护理,观察组给予聚焦解决模式健康教育。[结果]干预后观察组和对照组除药物管理外,饮食管理、运动管理、血糖监测和足部护理得分均高于对照组(P0.05)。[结论]聚焦解决模式健康教育可提高2型糖尿病病人自我管理能力。     

时机理论奠基式健康管理模式在高血压合并糖尿病患者中的 应用

目的探讨时机理论奠基式健康管理模式在高血压合并糖尿病患者中的应用效果。方法选取2018年1~12月深圳市福田区慢性病防治院新洲社康中心收治的高血压合并糖尿病患者92例为研究对象,按随机数字表法分为实验组和对照组各46例。对照组接受常规健康管理干预,实验组接受时机理论奠基式健康管理模式干预。比较两组干预后的健康行为遵医度、疾病控制效果及生活质量。结果实验组干预后6个月及12个月的健康行为遵医度及生活质量评分均显著高于对照组,差异有统计学意义(P<0.05),疾控效果显著优于对照组,差异有统计学意义(P<0.05)。结论采用时机理论奠基式健康管理模式对高血压合并糖尿病患者施加干预,可显著提升其健康行为遵医度及疾控效果,改善生活质量。     

中老年高血压患者的社区综合健康管理模式探索

目的 探索中老年高血压患者的社区综合健康管理模式.方法 选取中老年高血压120例,以调查对象的入院顺序进行编号,根据随机数字表分成两组.对照组按照普通管理,观察组按照社区健康管理模式管理.在饮食、运动及心理、中医等一系列健康的生活方式予以详细指导.1年后比较两组患者血压变化情况.结果 两组患者血压均较前有下降,其中社区...     

The treatment of hypertension in patients with diabetes

The most common cause of end-stage renal disease in the United States is diabetes mellitus. Data from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that near-normalization of blood glucose levels results in a significant reduction in the development and progression of diabetic nephropathy. The UKPDS, however, clearly demonstrated that tight control of blood pressure in patients with diabetes is associated with reductions in macrovascular disease. Hypertension is also a major contributor to the development of diabetic renal disease. It is currently recommended that individuals with diabetes maintain a blood pressure level of less than 130/85 to maximize renal protection. It is essential that health care practitioners are aware of the importance of assessing early evidence of renal disease such as microalbuminuria and monitoring the progression of nephropathy. This article reviews current guidelines for the management of hypertension in patients with diabetes. In particular, the rationale for the use of the major pharmacologic therapies available for the treatment of hypertension is explored.     

医院-社区-家庭三级健康管理模式在老年糖尿病患者中的应用研究

目的：探讨医院-社区-家庭三级健康管理模式对老年糖尿病患者治疗依从性及疗效的影响。方法于2011年9月至2013年8月,对120例接受社区门诊随诊的老年2型糖尿病患者进行跟踪随访,并将所有患者随机分为试验组和对照组,每组各60例。试验组采用医院-社区-家庭三级健康管理模式,对照组按常规方式管理。比较两组患者的治疗依从性、血糖控制水平和再住院次数。结果120例患者均完成为期2年的随访。试验组患者治疗依从性、血糖控制水平均明显优于对照组,再住院次数少于对照组,组间比较差异有统计学意义（P＜0．05）。结论医院-社区-家庭三级健康管理模式可明显提高老年糖尿病患者的治疗依从性,对糖尿病防控作用明显。     

Blood glucose management and treatment of hypertension in people with diabetes

With the increased knowledge obtained from more formal and rigorous clinical trails in recent years on the benefit of more intensive management of blood glucose and blood pressure in preventing or delaying the development and progression of diabetic micro- and macro-angiopathies, the challenges for routine clinical practice have become even greater. The complexity of the condition has also become evident, with realization that control of glucose, lipid and blood pressure levels, are all primary management goals.     

Drug treatment of hypertension in patients with diabetes mellitus.

Patients with diabetes mellitus have an increased prevalence of hypertension and its vascular consequences, including coronary and cerebrovascular disease. Drug treatment of hypertension in diabetic subjects is fraught with potential difficulties, including the altered efficacy of medications, the increased risk of side effects, and the possibility of worsening glycemic control and increasing serum lipid levels. Despite these difficulties, treatment is an important part of reducing morbidity and mortality from vascular events. Antihypertensive therapy may also have the potential to prevent or retard the development of diabetic nephropathy. In this article, we discuss the efficacy and metabolic and nonmetabolic side effects of the various classes of antihypertensive agents in patients with diabetes mellitus and suggest a stepped-care approach to the drug treatment of patients with hypertension and diabetes.     

Treatment gaps for hypertension management in rural Canadian patients with type 2 diabetes mellitus

BACKGROUND: There were a reported 2.2 million Canadians living with diabetes mellitus (DM) in 2002, of whom 1.98 million (90.0%) had type 2 DM. In addition, there are approximately 60,000 new cases of type 2 DM diagnosed in Canada each year. However, the research shows that evidence and guidelines for management of hypertension in DM are not always translated into clinical practice. In rural areas, factors affecting implementation of recommendations and/or guidelines are less well understood, although some studies suggest that urban practices provide higher quality of care overall than rural areas. OBJECTIVE: The goal of this study was to describe the patterns of medication use for hypertension for patients with type 2 DM in rural northern Alberta, Canada. We also tried to identify treatment gaps and opportunities for prescribing antihypertensives relative to the Canadian Diabetes Association's 1998 Clinical Practice Guidelines for the Management of Diabetes in Canada and the Canadian Hypertension Society Recommendations Working Group's 2003 Canadian Recommendations for the Management of Hypertension: Therapy. METHODS: This study was conducted at the Institute of Health Economics and the University of Alberta (Edmonton, Alberta, Canada). We collected information from a cohort of patients aged >or =20 years with type 2 DM living in 2 adjacent rural regions of northern Alberta, Canada, at the time of enrollment in a diabetes care quality-improvement program as part of the Diabetes Outreach Van Enhancement (DOVE) study. Treatment gaps were determined by comparing antihypertensive pharmacotherapy with a blood pressure (BP) target of < or =130/< or =85 mm Hg. We used multivariate regression analyses to determine the associations between sociodemographic and clinical characteristics and treatment gaps. RESULTS: A total of 392 patients (229 women, 164 men; mean [SD] age, 62.3 [12.5] years) with type 2 DM were included in this analysis. Patients had a mean (SD) duration of diabetes of 8.3 (8.5) years. A total of 75.8% (297/392) of the study population had hypertension, and most (236/392[60.2%]) were receiving some pharmacotherapy. Treatment gaps were present; 42.7% (n = 67) of patients not receiving pharmacotherapy for hypertension were above the established BP targets. For patients receiving monotherapy, 70% were not at BP targets. For patients receiving dual, triple, and > or =4 medications, 65%, 66%, and 46%, respectively, were not at BP targets. After controlling for systolic blood pressure, male sex (adjusted odds ratio [aOR], 2.17; 95% CI, 1.17-4.03), older age (aOR, 1.80 per decade; 95% CI, 1.51-2.09), lower self-reported physical health (aOR, 0.68; 95% CI, 0.41-0.96), higher body mass index (aOR, 1.05; 95% CI, 1.01-1.10), and past/current smoking (aOR, 1.95; 95% CI, 1.01-3.76) were all significantly associated with a lack of treatment for hypertension. CONCLUSIONS: Treatment maps in the management of hypertension exist in these rural Canadian patients with type 2 DM. Cardiovascular risk may be underestimated in these patients, particularly among younger patients and women, and those with multiple non-DM risk factors. These are patient subgroups that should be targeted as opportunities to improve hypertension management at the population level.     

“互联网+”慢性病管理模式在2型糖尿病患者中的应用

目的 探讨基于“互联网+”理念的慢性病管理模式对2型糖尿病患者的干预效果。方法 便利选取从综合性医院转介横山桥社区的2型糖尿病患者100例,用随机数字表分为实验组和对照组。实验组由慢性病管理师采用“互联网+”医院社区一体化慢性病管理模式进行管理,对照组进行常规糖尿病管理。干预3个月、6个月、12个月时,分别测评两组空腹和餐后2h血糖、糖化血红蛋白、自我管理能力与生活质量等指标,并进行比较。结果 实验组46例、对照组45例完成研究。干预3个月、6个月、12个月时,两组的空腹血糖、餐后2h血糖、糖化血红蛋白均有不同程度下降,自我管理能力和生活质量也有不同程度的提升,实验组空腹血糖、自我管理行为量表的饮食控制维度和总分、糖尿病患者生活质量量表各维度和总分优于对照组,差异具有统计学意义（均P<0.05）。干预12个月时实验组的糖化血红蛋白与对照组相比,差异有统计学意义（P<0.05）。结论 基于“互联网+”理念的医院社区一体化慢性病管理模式可以有效降低血糖水平, 提高糖化血红蛋白达标率和患者自我管理效能,有利于预防和延缓糖尿病并发症的发生与发展。     

综合健康教育干预在高血压病人护理中应用

高血压作为心血管疾病的高危因素，极大地危害人类的健康。有研究显示，我同人群高血压知晓率为30．2％，治疗率为24．7％，控制率仅为6．1％^[1]。而宣传有效的信息，可提高高血压病人的支持水平^[2]。鉴于此，笔者对我科64例高血压病人实施综合健康教育护理干预，效果较好。现报道如下。