护理干预在改善老年糖尿病人营养状况中的应用

论文编号:HL201  论文字数:15116.页数:26

论文题目：护理干预在改善老年糖尿病人营养状况中的应用
摘 要
 研究目的
 通过对2 型糖尿病患者(type 2 diabetes metillus,T2DM)进行个体化健
康教育及个体化、量化饮食护理，探讨适合本地区饮食习惯的糖尿病饮食护理
模式，提高患者生活质量。
 研究方法
 在我市48 个社区中随机选取4个社区，在社区内以自愿为原则选择100 例T2DM 患者作为研究对象，采用食物频率表调查患者营养状况并测量空腹血糖及糖化血红蛋白水平。对照组患者接受群体健康教育，护理组患者在群体健康教育基础上接受个体化健康教育及个体化、量化饮食指导。护理三个月后评价血糖、糖化血红蛋白控制情况。
 研究结果
  (1) 护理前T2DM 患者的营养状况，总能量(男，2215kcal vs. 1900kcal;女，1897kcal vs. 1800kcal)高于营养治疗原则推荐值(P<0.05)，能量来源分配不合理，脂肪供热比为32%，高于推荐摄入量(20%~30%)，碳水化合物供热比为52%， 低于推荐摄入量(55%~60%).维生素C(70.85±61.25mg vs. 100mg)、维生素B1(0.87±0.38mg vs. 1.3mg) 、维生素E(7.02±3.23mg vs. 10mg) 及钙(706.93±311.97mg vs. 1000mg) 的摄入量明显低于推荐摄入量. (2) 护理前两组患者对糖尿病相关知识知晓率普遍较低。护理结束后，对照组和护理组对各项知识的知晓率均有所提高，且从提高的百分率看，护理组提高更为明显。护理前对照组和护理组患者对能否预防糖尿病、能否控制糖尿病及控制糖尿病的信心差异无统计学意义(P>0.05)。
 研究结论
 (1) T2DM 患者营养状况：总能量摄入过高；热能来源比例分配不当；某些维生素及矿物质摄入不合理；膳食纤维摄入量也明显低于推荐摄入量。
 (2)个体化健康教育及个体化、量化饮食能够通过增加患者的知识，改变患者的态度，进而改变不良行为，从而有效控制血糖。
 
关键词: 2型糖尿病；体重指数；空腹血糖  营养治疗

研究类型：类实验性研究

 Title: The effective of dietary intervention in patients with old Diabetes Mellitus
ABSTRACT
 Objective: To explore the reasonable dietary intervention mode of type 2 diabetes mellitus (T2DM) and to improve the quality of life in patients with T2DM.Through group health education among all the patients and quantized dietary intervention in individual.
 Methods: Randomly sampled four communities among 48 communities in Tangshan city. 25 volunteers with T2DM were selected in every community. A total of 100 patients were randomly allocated into the control group and the intervention group on the base of community. The nutrition status of subjects was investigated by Food Frequency Questionnaire, and fasting plasma glucose (FPG) and HbAlc were tested. All the subjects received health education and dietary counseling both in control group and the intervention group within 3 months. Additionally the subjects in the intervention group received individualized health education and quantized dietary counseling from community doctors who were trained during the period of intervention.
 Results:(1) The intake of total energy (men, 2215kcal vs. 1900kcal; women,1897kcal vs. 1800kcal) was significantly higher than nutrition therapy principle recommendation value (P<0.05). The proportion of energy resources wasunreasonable. The fat (32% vs. 20%~30%) and the carbohydrate (52% vs.55%~60%) were higher and lower than recommendation nutrition intake (RNI). (2)Before the intervention, the rates of awareness among all the subjects are generally low. After the intervention, though the rates of awareness both in the control group and the intervention group rose, the rate in the intervention group rose more than in the control group. Before the intervention, the rates of attitude and confidence related with diabetes between two groups were not significantly different (P>0.05).
 Conclusion: The result indicates that，based on correctly evaluating the behavior state of patients，paramedic staff should apply the“Family—Centered Care”principle to practice psychological health education to the NS children and their whole families．These Call not only boost the combined therapy efficacy of disease，but also promote optimization of the family environment，which Can improve the life quality and enhance attending ability of family members，and then achieve the real meaning health．At the same time，it also provide new theory basis and methods for pediatrics clinic nursing practice．

Key words:type 2 diabetes mellitus; individualized; health education; dietary intervention
Type:Experimental research

 目  录
 摘 要 IV
ABSTRACT V
1 绪论 1
1.1背景及意义 1
1.2目的和目标 2
1.3关键词及定义 2
1.3.1体重指数 2
1.3.2空腹血糖 2
1.3.3 2型糖尿病 2
1.4 文献回顾 2
1.4.1老年糖尿病人饮食治疗的意义 2
1.4.2老年糖尿病人饮食治疗的现状 4
1.4.3老年糖尿病人膳食结构的现状 5
2 研究设计 7
2.1研究设计 7
2.2研究对象 7
2.3研究工具 7
2.4研究步骤 7
2.5统计分析 8
3.结果 9
3.1一般情况比较 9
3.2护理前患者营养状况 9
3.2.1能量摄入状况及三大营养素供热比 9
3.2.2营养素摄入状况 9
4.讨论 11
4.1T2DM患者的营养状况 11
4.1.1能量摄入状况及来源分配 11
4.1.2维生素 11
4.1.3矿物质 12
4.1.4胆固醇与膳食纤维 12
4.2个体化、量化饮食护理效果评价 13
5.推论与建议 15
5.1结论 15
5.2建议 15
5.3本研究局限性及展望 15
致    谢 16
 参考文献 17