视觉和行为干预在糖尿病患者初用胰岛素期间的应用

目的探讨视觉和行为干预在糖尿病患者初次皮下注射胰岛素期间的应用效果。方法将158例初次皮下注射胰岛素的糖尿病患者随机分成干预组79例和对照组79例。对照组给予常规的胰岛素笔使用、胰岛素相关知识干预，发放糖尿病干预手册、胰岛素笔使用说明书、血糖监测日记，干预组在此基础上给予视觉和行为干预。两组患者初次注射胰岛素后即刻采用视觉模拟评级法（VAS）进行注射疼痛评分，治疗前及治疗4周后采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、社会支持评定量表（SSRS）和患者满意度量表进行调查，比较两组VAS、SAS、SDS、SSRS评分，干预前后血糖变化及满意度情况。结果干预组患者初次注射胰岛素VAS评分（0．82±0．72）分明显低于对照组（3．21±1．22）分，差异具有统计学意义（t=2．37，P〈0．01）；干预组患者干预前SAS、SDS、患者满意度、SSRS评分（46．71±13．88），（49．45±12．53），（6．31±0．68），（40．78±1．45）分与对照组患者（47．98±11．06），（48．81±10．29），（6．51±0．65），（41．42±1．63）分比较，差异均无统计学意义（t分别为1．63，3．32，10．87，3．23；P〉0．05）；干预4周后干预组患者SAS、SDS评分（38．68±6．03），（38．35±5．19）分及对照组患者SAS、SDS评分（44．93±8．26），（46．10±8．23）分均低于干预前，差异均有统计学意义（t分别为15．02，24．50，7．71，11．87；P〈0．01），且干预组SAS、SDS评分均低于对照组，差异均有统计学意义（t分别为2．07，2．28；P〈0．05）；干预4周后干预组患者满意度和SSRS评分（8．50±0．33），（44．31±3．84）分及对照组患者满意度和SSRS评分（6．71±0．59），（42．76±0．76）分均高于干预前，差异均有统计学意义（t分别为16．51，8．81，3．22，2.88；P〈0．05），且干预组患者满意度和SSRS评分均高于对照组，差异均有统计学意义（t分别为6．50，2．82；P〈0．05）；两组患者干预前空腹血糖及餐后2h血糖，差异均无统计学意义（P〉0．05）；干预4周后干预组患者空腹血糖（5．99±0．92）mmol／L，餐后2h血糖（7．82±1．38）mmol／L，均低于对照组（7．26±1．92），（9．13±1．36）mmol／L，差异均有统计学意义（t分别为5．77，6．12；P〈0．05）。结论应用视觉和行为干预能有效减轻初用胰岛素患者的焦虑、抑郁及痛感，降低空腹及餐后血糖，提高患者的满意度及社会支持度。

Application of visual and behavioral intervention in diabetics start using insulin period

Objective To explore the application effects of visual and behavioral intervention in diabetics start using insulin period. Methods Totals of 158 diabetics with start using insulin for the first time were randomly divided into intervention group （79 cases） and control group （79 cases）. Control group received intervention of conventional insulin pen utilization and relative insulin knowledge, and diabetes intervention manual, introduction of insulin pen utilization were provided to patients, and patients wrote blood glucose monitoring diary. On this basic, intervention group received visual and behavioral intervention . Visual simulation rating method （VAS）was used when patients first used insulin to measure injection pain score, before and after four cure four weeks, patients were investigated with self-anxious scale（ SAS）, self-depression scale （SDS）, selfsocial support scale （SSRS） and patients＇ satisfaction degree, then those score, blood glucose change were compared. Results The VAS score of intervention group was （ 0.82 ± 0.72 ） obviously lower than （ 3.21 ± 1.22 ） of control group, and the difference was statistically significant （t = 2. 37, P 〈 0. 01 ）. Before intervention, the score of SAS、SDS、paticnts＇ satisfaction degree and SSRS in intervention group in order was （46.71 ± 13.88 ） , （49.45± 12.53 ）, （6.31± 0.68 ）, （40.78± 1.45 ） and compared with control group that in order was（47.98 ± 11.06）, （48.81 ± 10.29）, （6.51±0. 63）, （41.42 ± 1.63）,differences was statistically significant（t = 1. 63,3. 32,10. 87,3.23;P 〉 0. 05 ）. After intervention four weeks, the score of SAS, SDS of intervention group respectively was （ 38.68 ±6.03 ）, （ 38.35± 5. 19 ） and that of control group was （ 44.93 ± 8.26 ）, （46.10 ± 8.23 ）, lower than before intervention and the difference was statistically significant（ t = 15.02, 24. 50,7. 71,11.87 ,respectively;P 〈0. 01 ） ; the score of SAS,SDS of intervention group was lower than that of control group, the difference was statistically significant （ t = 2. 07,2. 28 ; P 〈 0. 05 ）. After intervention four weeks, SSPS score and patients＇ satisfaction degree was （ 44.31 ±3.84 ） and （ 8.50 ± 0.33 ） , and that of control group was （ 42.76 ± 0.76 ） and （ 6.71 ±0. 59 ） , both higher than before intervention, the difference was statistically signifieant（t = 8. 81,16. 51,2. 88,3. 22, respectively; P 〈 0. 05 ）, SSPS score and patients＇ satisfaction degree of intervention group was higher than that of control group, the difference was statistically significant（ t = 2. 82,6. 50, respectively; P 〈 O. 05 ）. There was no difference between two groups in fasting blood-glucose（FBG） and two hours after meal（ P 〉 0. 05 ）. After intervention four weeks, FBG and two hours after meal of intervention group was （ 5.99 ± 0. 92 ） mmol/L, （ 7.82 ± 1.38 ） mmol/L, both lower than that of control group which was （ 7.26 ± 1. 92 ） mmol/L, （ 9. 13 ± 1. 36 ） mmol/L, the difference was statistically significant （ t = 5.77,6. 12, respectively ; P 〈 0. 05 ）. Conclusions Adopting visual and behavioral interventions for diabetics in start using insulin period can effectively reduce anxiety, depression, pain, decrease fasting bloodglucose and two hours after meal blood-glucose, and improve patient ＇ s satisfaction and social support.