基于复元理念的个体化干预对精神分裂症合并糖尿病患者的护理研究

林玲; 张毅; 何美

doi:10.16766/j.cnki.issn.1674-4152.003270

基于复元理念的个体化干预对精神分裂症合并糖尿病患者的护理研究

doi: 10.16766/j.cnki.issn.1674-4152.003270

上海市精神卫生中心B3病区，上海 201108

基金项目:

上海市科学技术委员会科技计划项目 21Y11905700

详细信息

通讯作者:
林玲, E-mail: linling0814@126.com

中图分类号: R749.3R587.1R473.74
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-26
- 网络出版日期: 2024-01-13

Study on nursing care of schizophrenia patients with diabetes by individualized intervention based on recovery concept

B3 Ward, Shanghai Mental Health Center, Shanghai 201108, China

摘要

摘要: 目的精神分裂症合并糖尿病的护理需高度重视，本研究探讨基于复元理念的个体化护理干预的应用效果。方法选取2020年9月—2022年8月上海市精神卫生中心收治的122例精神分裂症合并糖尿病患者，采用随机数表法分为对照组和观察组，每组各61例。对照组实施常规护理干预，观察组实施基于复元理论的个体化护理干预。2组均干预6个月，比较2组干预前后自知力与治疗态度[自知力与治疗态度问卷(ITAQ)]、病耻感[精神疾病内在病耻感调查表(ISMI)]、治疗依从性、临床精神症状[阳性与阴性症状量表(PANSS)]、血糖指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)及餐后2 h血糖(2hPG)]，并记录2组干预6个月后血糖达标情况及干预期间精神分裂症疾病复发情况。结果干预后，观察组ITAQ量表评分高于对照组(P＜0.05)，ISMI各维度评分及总分低于对照组(P＜0.05)。观察组依从性优良率为91.53%(54/59)，高于对照组[77.97%(46/59), P＜0.05]。干预后，观察组PANSS各维度评分及总分低于对照组(P＜0.05)，FPG、2hPG及HbA1c水平低于对照组(P＜0.05)。干预6个月后，观察组血糖达标率高于对照组[74.58%(44/59)vs. 55.93%(33/59), P＜0.05]。结论基于复元理念的个体化干预能提升精神分裂症合并糖尿病患者的自知力，降低病耻感，利于其精神康复及血糖稳定。
- 精神分裂症 /
- 糖尿病 /
- 复元理念 /
- 临床精神症状 /
- 控糖效果
Abstract: Objective The nursing of schizophrenia complicated with diabetes should be paid more attention. This study discusses the application effect of individualized nursing intervention based on the concept of rehabilitation. Methods A total of 122 patients with schizophrenia combined with diabetes admitted to Shanghai Mental Health Center from September 2020 to August 2022 were selected and divided into control group and observation group by random number table method, with 61 cases in each group. The control group implemented routine nursing intervention, while the observation group implemented individualized nursing intervention based on recovery theory. Both groups were intervened for 6 months, and their self-awareness and treatment attitude [insight and treatment attitude questionnaire (ITAQ)], stigma [internalized stigma of mental illness inventory (ISMI)], treatment compliance, clinical psychiatric symptoms [positive and negative syndrome scale (PANSS)], blood glucose indicators [fasting blood glucose (FPG), glycated hemoglobin (HbAlc) and 2 hour postprandial plasma glucose (2hPG)] were compared before and after the intervention, and the blood glucose level after 6 months of intervention in both groups were recorded, as well as the recurrence of schizophrenia during the intervention period. Results After intervention, the ITAQ scale score in the observation group was higher than that in the control group (P < 0.05), while the ISMI scores and total scores in all dimensions were lower than those in the control group (P < 0.05). The excellent and good compliance rate in the observation group was 91.53% (54/59), which was higher than 77.97% (46/59) in the control group (P < 0.05). After intervention, the PANSS scores in all dimensions and total scores in the observation group were lower than those in the control group (P < 0.05), and the levels of FPG, 2 h PG, and HbA1c were lower than those in the control group (P < 0.05). After 6 months of intervention, the blood glucose compliance rate in the observation group was higher than that in the control group [74.58% (44/59) vs. 55.93% (33/59), P < 0.05]. Conclusion Individualized intervention based on the concept of recovery can improve the insight of schizophrenic patients with diabetes, reduce their sense of shame, and facilitate their mental rehabilitation and blood sugar stability.
- Schizophrenia /
- Diabetes /
- Concept of recovery /
- Clinical psychiatric symptoms /
- Sugar control effect

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表 1 2组精神分裂症合并糖尿病患者一般资料比较

Table 1. Comparison of general data between two groups of patients with schizophrenia and diabetes

组别	例数	性别(例)		年龄 (x±s，岁)	精神分裂症病程 (x±s，年)	糖尿病病程 (x±s，年)	受教育年限 (x±s，年)	婚姻状况[例(%)]
组别	例数	男性	女性	年龄 (x±s，岁)	精神分裂症病程 (x±s，年)	糖尿病病程 (x±s，年)	受教育年限 (x±s，年)	已婚	未婚	其他
对照组	59	39	20	51.53±10.34	5.42±1.34	3.52±1.01	12.35±2.96	39(66.10)	10(16.95)	10(16.95)
观察组	59	33	26	52.26±10.21	5.51±1.38	3.57±1.06	12.57±3.12	35(59.32)	16(27.12)	8(13.56)
统计量		1.283^a		0.386^b	0.360^b	0.262^b	0.393^b	1.823^a
P值		0.257		0.700	0.720	0.794	0.695	0.402
注：^a为χ²值，^b为t值。

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表 2 2组精神分裂症合并糖尿病患者ITAQ量表评分比较(x±s，分)

Table 2. Comparison of ITAQ scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	干预前	干预后
对照组	59	10.52±3.68	13.86±4.67^a
观察组	59	10.35±3.52	15.83±5.12^a
t值		0.256	2.184
P值		0.798	0.031
注：与同组干预前比较，^aP＜0.05。

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表 3 2组精神分裂症合并糖尿病患者ISMI评分比较(x±s，分)

Table 3. Comparison of ISMI scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	疏远		刻板认同		歧视经历		社会退缩		病耻感抵抗		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	59	18.95±2.45	16.22±2.09^a	21.12±3.25	18.53±2.84^a	15.47±2.29	13.21±1.86^a	18.75±2.37	15.34±2.03^a	16.37±2.71	13.98±2.06^a	90.66±6.35	77.10±5.26^a
观察组	59	19.09±2.53	14.23±1.84^a	21.33±3.36	16.31±2.55^a	15.58±2.38	11.23±1.61a	18.61±2.23	13.61±1.79^a	16.25±2.57	12.48±1.79^a	90.86±6.44	67.86±4.67^a
t值		0.305	5.489	0.345	4.468	0.256	6.182	0.330	4.910	0.247	4.222	0.170	10.090
P值		0.761	＜0.001	0.731	＜0.001	0.799	＜0.001	0.742	＜0.001	0.806	＜0.001	0.865	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 4 2组精神分裂症合并糖尿病患者治疗依从性优良率比较

Table 4. Comparison of good to good ratio of treatment compliance between two groups of patients with schizophrenia and diabetes

组别	例数	完全依从 [例(%)]	部分依从 [例(%)]	不依从 [例(%)]	依从性优良率(%)
对照组	59	25(42.37)	21(35.60)	13(22.03)	77.97(46/59)
观察组	59	38(64.41)	16(27.12)	5(8.47)	91.53(54/59)
注：2组依从性优良率比较，χ²=4.196，P=0.041。

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表 5 2组精神分裂症合并糖尿病患者PANSS评分比较(x±s，分)

Table 5. Comparison of PANSS scores between two groups of patients with schizophrenia and diabetes (x±s, points)

组别	例数	阳性症状		阴性症状		一般精神病理		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	59	16.59±5.31	14.46±4.52^a	21.72±6.26	17.53±5.34^a	37.94±8.24	34.45±5.79^a	76.25±8.51	66.44±7.18^a
观察组	59	17.06±5.42	11.81±3.74^a	21.34±6.17	15.08±3.61^a	38.03±8.38	31.25±5.13^a	76.43±8.82	58.14±6.67^a
t值		0.476	3.470	0.332	2.706	0.059	3.177	0.112	6.505
P值		0.635	0.001	0.740	0.008	0.953	0.002	0.910	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 6 2组精神分裂症合并糖尿病患者FPG、2hPG及HbA1c水平比较(x±s)

Table 6. Comparison of FPG, 2hPG and HbA1c levels between two groups of patients with schizophrenia and diabetes (x±s)

组别	例数	FPG(mmoL/L)		2hPG(mmoL/L)		HbA1c(%)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	59	9.14±2.53	7.53±1.12^a	12.52±2.63	9.42±1.62^a	8.64±2.11	7.13±1.74^a
观察组	59	9.23±2.61	6.65±0.87^a	12.44±2.56	7.83±1.47^a	8.71±2.16	6.21±1.54^a
t值		0.190	4.766	0.164	5.583	0.178	3.041
P值		0.850	＜0.001	0.867	＜0.001	0.859	0.003
注：与同组干预前比较，^aP＜0.05。

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