以区医疗中心为主导糖尿病立体化管理模式效果研究.docVIP

以区医疗中心为主导的糖尿病立体化管理模式的效果研究 　　[摘要] 目的 探索以区医疗中心为主导，社区医疗团队为服务中心，利用网络平台对糖尿病患者进行管理的有效性。 方法 2015年1月，在北京市通州区觅子店卫生院所管辖的2型糖尿病患者中抽取200名患者作为干预组，通州区潞城镇卫生院所管辖的2型糖尿病抽取200名患者作为对照组，干预组采取以区医疗中心为主导的糖尿病立体化管理模式对糖尿病患者进行管理、随诊，对照组采取自然管理的办法，门诊正常挂号看病，根据患者情况嘱定期复查。监测血压、血糖、糖化血红蛋白、胰岛素水平、血脂、尿酸、颈动脉内膜厚度水平、尿微量蛋白肌酐比值等指标。随访1年，至2016年1月，计算血糖达标率、规范管理率、综合达标率。 结果 经过1年管理后，干预组空腹血糖、糖化血红蛋白、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿微量白蛋白/肌酐较对照组低，差异有统计学意义（P 0.05）。 结论 通过干预组的管理，不仅使糖尿病患者糖化血红蛋白长期达标，而且规范化管理率、综合达标率也得到很大的提高。 　　[关键词] 2型糖尿病；社区管理；综合达标率；规范管理率 　　[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-7210（2016）08（b）-0126-05 　　[Abstract] Objective To explore the management effectiveness of diabetic patients that dominated by regional medical center， with community health as service center. Methods 200 diabetic patients which from Mizidian Health care center of Tongzhou and 200 diabetic patients which from Lucheng Health Care Center of Tongzhou were randomly selected as treatment group and control group in January 2015. The treatment group of patients was managed and been follow-up through the Diabetic Multidimensional Management Mode which dominated by Regional Medical Center Care， and the control group of patients had no special intervention. All of patients in two groups would been monitored indexes such as blood pressure， blood sugar， glycosylated hemoglobin， insulin concentration， blood lipids， uric acid levels， trace protein urine creatinine ratio and carotid intima media thickness， etc. After 1 year of follow-up， the target rate of blood glucose， the definition of standard management and the comprehensive target ratio was been calculated. Results After 1 year of management， fasting glucose， glycosylated hemoglobin， cholesterol， high-density lipoprotein cholesterol， low density lipoprotein cholesterol， urine trace albumin/creatinine of trentment group were lower than those of control group， which remained statistically significant （P 0.05）. Conclusion Through the use of diabetic multidimensional management mode that dominated by re