246例糖尿病足的临床特点和循证护理的疗效分析

目的探讨糖尿病足患者的临床特点及循证护理的疗效。方法收集2000年5月—2012年5月在北京朝阳医院京西院区住院的患者246例,随机分为循证护理组（122例）和一般护理组（124例）。循证护理组采用循证护理方案,一般护理组采用基础护理方案。收集患者糖尿病足发生的诱因、血糖、血压、血脂、糖化血红蛋白（HbA1c）、住院天数、预后等资料,并在患者出院3个月后进行电话随访评价每日坚持足部护理的依从性。结果糖尿病足通常发生在老年、糖尿病病程长、血糖及血压控制差的患者中,61.4%（151/246）的患者有明确的诱因,发生率随年龄增加而升高（χ2=30.42,P〈0.01）。循证护理组较普通护理组血糖、血压、血脂控制好（P〈0.01或P〈0.05）,住院时间短（P〈0.01）,总的治疗有效率（P〈0.01）高,出院后患者每日坚持足部护理的依从性高（χ2=8.739,P〈0.01）。结论循证护理能有效防治糖尿病足,提高患者长期足部护理的依从性,预防足溃疡的复发,降低糖尿病足患者的截肢风险。

clinical characteristics and efficacy of evidence-based nursing on 246 patients with diabetic foot

Objective]To explore the clinical characteristic of diabetic foot patients and investigate the efficacy of evidence-based nursing.Methods]A total of 246 inpatients with diabetic foot in Beijing Chaoyang Hospital during May 2000-May 2012,were randomly divided into the general nursing group（GNG,n = 124） and the evidence-based nursing group（EBNG,n = 122）. Patients in GNG were given the conventional nursing care plan,and patients in the EBNG were given the evidence-based nursing care plan.The clinical parameters（ including inducing factors,plasma glucose,blood pressure,serum lipid,glycosylated hemoglobin（HbA1c）,hospitalized days,prognosis） were recorded,the patients were followed up via telephone interview after 3 months to assess the compliance of diabetic foot nursing care.Results]Diabetic foot often occurred in elderly patients with long diabetic disease course,and poor control of plasma glucose and blood pressure. Among them,61. 4%（151 /246） had clear inducement. With age increasing,the prevalence of diabetic foot increased（χ2= 30. 42,P〈0. 01）. The post-treatment plasma glucose,blood pressure and serum lipid were controlled better in the EBNG than those in the GNG significantly（P〈0. 01 or P〈0. 05）. The average days in hospital in the EBNG was significantly lower than that of GNG（ P〈0. 01）,while the total effective rate was on the contrary（P 0.01）. The feet nursing care compliance of EBNG was superior to that of GNG after discharge（χ2= 8. 739,P〈0. 01）.Conclusion]The evidence-based nursing is an effective therapy for diabetic foot patients,it can improve the long-term compliance of diabetic foot care,prevent the recurrence of foot ulcers,and reduce the risk of amputation in patients with diabetic foot.