Application of planned behavioral intervention model in Vacuum sealing drainage for diabetic foot ulcer
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摘要:
目的 分析计划行为干预模式在糖尿病足溃疡创面封闭负压吸引中的临床疗效和对患者血糖控制及自我管理的影响。 方法 选取2021年1月—2024年11月在海军第九七一医院接受治疗的112例糖尿病足溃疡患者开展研究，采用随机数表法将患者分为对照组与观察组，各56例。对照组实施常规护理干预措施，观察组则在常规干预基础上，结合计划行为理论开展计划行为干预措施，比较2组的疗效、临床康复时间指标以及干预前、干预1个月后、干预3个月后的血糖水平及糖尿病自我管理教育和支持量表（DSMES）评分、生活质量测定量表-100（QOL-100）评分。 结果 观察组总有效率达89.29%（50/56），较对照组的60.71%(34/56)显著提升，差异有统计学意义（χ2=14.730，P=0.002）。观察组肉芽明显出现时间、创面愈合时间以及住院时间均少于对照组，差异均有统计学意义（P＜0.05）。干预前，2组空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)水平、DSMES、QOL-100评分差异无统计学意义，干预1个月、2个月、3个月，观察组FPG、2hPG、HbA1c均低于对照组，DSMES、QOL-100评分均高于对照组，差异均有统计学意义（P＜0.05）。 结论 计划行为干预模式应用于糖尿病足溃疡创面封闭负压吸引患者效果显著，可提高总有效率，缩短创面愈合等时间，降低血糖水平，提升自我管理能力及生活质量。 Abstract:Objective To analyze the clinical efficacy of planned behavior intervention mode in Vacuum sealing drainage for closure of diabetes foot ulcer wounds and its impact on patients' blood sugar control and self-management. Methods A total of 112 patients diagnosed with diabetic foot ulcer at No.971 Hospital of the PLA NAVY from January 2021 to November 2024 were chosen as the subjects of the study. They were randomly allocated into a control group and an observation group, 56 patients each group. The control group received routine nursing care, whereas the observation group was provided with nursing care based on the planned behavior theory in addition to the routine nursing interventions. The curative effect and clinical recovery time indicators, blood glucose levels before intervention, 1 month after intervention, and 3 months after intervention, as well as the scores of diabetes self-management education and support scale (DSMES) and quality of life scale-100 (QOL-100) were compared between the two groups. Results The observation group demonstrated a notably higher total effective rate of 89.29% (50/56) compared to the control group [60.71% (34/56), χ2=14.730, P=0.002]. Additionally, the observation group exhibited shorter durations for noticeable granulation, wound healing, and hospital stay than the control group (P < 0.05). Before the intervention, there was no difference in fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c) levels, diabetes self-management education and support (DSMES), and QOL-100 scores between the two groups. At 1 month, 2 months, and 3 months after the intervention, FPG, 2hPG, and HbA1c in the observation group were lower than those in the control group, while DSMES and QOL-100 scores were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion The application of planned behavior theory nursing mode in in Vacuum sealing drainage for diabetic foot ulcer has significant effect, which can improve the total effective rate, shorten the wound healing time, reduce blood glucose level, and improve self-management ability and quality of life. -
Key words:
- Diabetic foot ulcer /
- Planned behavior theory /
- Vacuum sealing drainage /
- Self-management
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表 1 2组糖尿病足溃疡患者一般资料比较
Table 1. Comparison of general data of 2 groups of patients with diabetic foot ulcers
组别 例数 年龄(x±s，岁) 性别(男性/女性，例) 文化水平(小学及以下/初中或中专/高中或大专/本科及以上，例) 糖尿病病程(x±s，年) BMI(x±s) 糖尿病足Wagner分级(Ⅰ级/Ⅱ级/Ⅲ级/Ⅳ级，例) 对照组 56 61.63±5.80 32/24 9/23/18/6 5.36±1.93 22.37±1.89 12/18/17/9 观察组 56 62.36±6.10 34/22 10/20/18/8 5.48±2.08 22.49±2.16 13/20/15/8 统计量 0.651a 0.148b -0.300c 0.330a 0.314a -0.488c P值 0.516 0.701 0.764 0.742 0.754 0.626 注：a为t值，b为χ2值，c为Z值。 
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表 2 2组糖尿病足溃疡患者总有效率比较[例(%)]
Table 2. Comparison of the total effective rate between the two groups of patients with diabetic foot ulcers[cases(%)]
组别 例数 完全康复 显著改善 部分有效 治疗无效 总有效 对照组 56 8(14.29) 16(28.57) 10(17.86) 22(39.29) 34(60.71) 观察组 56 20(35.71) 20(35.71) 10(17.86) 6(10.71) 50(89.29) 注：2组总有效率比较，χ2=14.730，P=0.002。
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表 3 2组糖尿病足溃疡患者临床康复时间指标比较(x±s，d)
Table 3. Comparison of clinical rehabilitation time indicators for two groups of patients with diabetic foot ulcers(x±s, d)
组别 例数 出现明显肉芽时间 创面愈合时间 住院时间 对照组 56 10.10±2.47 34.16±5.91 13.11±2.90 观察组 56 6.52±2.18 22.23±4.43 7.57±2.27 t值 8.150 12.088 11.240 P值 ＜0.001 ＜0.001 ＜0.001
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表 4 2组糖尿病足溃疡患者干预前后FPG、2hPG、HbA1c比较(x±s)
Table 4. Comparison of FPG, 2hPG and HbA1c before and after intervention in 2 groups of patients with diabetic foot ulcers(x±s)
组别 例数 FPG(mmol/L) 干预前 干预1个月 干预2个月 干预3个月 对照组 56 8.85±1.14 8.43±1.24a 8.05±1.17ab 7.27±1.31abc 观察组 56 8.86±1.37 8.09±1.28a 7.70±1.36ab 6.32±1.40abc F值 0.085 1.455 1.474 3.714 P值 0.933 0.049 0.043 ＜0.001 组别 例数 2hPG(mmol/L) 干预前 干预1个月 干预2个月 干预3个月 对照组 56 14.32±2.17 13.24±2.20a 12.16±2.25ab 11.48±2.11abc 观察组 56 14.17±2.28 12.55±2.22a 11.30±2.22ab 9.26±2.24abc F值 0.368 1.663 2.026 5.406 P值 0.714 0.049 0.045 ＜0.001 组别 例数 HbA1c(%) 干预前 干预1个月 干预2个月 干预3个月 对照组 56 7.00±0.65 6.52±0.72a 6.02±0.66ab 5.36±0.66abc 观察组 56 7.02±0.73 6.02±0.85a 5.48±0.90ab 4.89±0.82abc F值 -0.124 3.421 3.625 3.288 P值 0.901 0.001 ＜0.001 0.001 注：FPG，F组间=9.664、P组间=0.002；F时点=53.972、P时点＜0.001；F交互=2.907、P交互=0.035；2hPG，F组间=22.416、P组间＜0.001；F时点=62.193、P时点＜0.001；F交互=4.408、P交互=0.005；HbA1c，F组间=33.075、P组间＜0.001；F时点=119.470、P时点＜0.001；F交互=3.203、P交互=0.023。与同组干预前比较，aP＜0.05；与同组干预1个月比较，bP＜0.05；与同组干预2个月比较，cP＜0.05。
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表 5 2组糖尿病足溃疡患者干预前后DSMES、QOL-100评分比较(x±s，分)
Table 5. Comparison of DSMES and QOL-100 scores before and after intervention in 2 groups of patients with diabetic foot ulcers(x±s, points)
组别 例数 DSMES QOL-100 干预前 干预1个月 干预2个月 干预3个月 干预前 干预1个月 干预2个月 干预3个月 对照组 56 57.59±4.28 64.36±4.25a 70.30±4.39ab 80.38±4.40abc 44.89±5.92 50.13±5.97a 60.25±4.95ab 68.46±4.98abc 观察组 56 56.98±4.78 69.25±4.78a 78.25±4.84ab 88.36±4.79abc 45.09±6.83 58.09±4.72a 70.95±4.88ab 82.14±4.78abc F值 0.708 5.723 9.104 9.181 0.163 7.832 11.520 14.834 P值 0.480 ＜0.001 ＜0.001 ＜0.001 0.871 ＜0.001 ＜0.001 ＜0.001 注：DSMES，F组间=146.637、P组间＜0.001；F时点=690.439、P时点＜0.001；F交互=21.436、P交互＜0.001。QOL-100，F组间=219.291、P组间＜0.001；F时点=700.883、P时点＜0.001；F交互=33.456、P交互＜0.001。与同组干预前比较，aP＜0.05；与同组干预1个月比较，bP＜0.05；与同组干预2个月比较，cP＜0.05。
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