本文選題：糖尿病 + 胰島素筆注射　； 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:通過對胰島素筆注射后藥液漏出現(xiàn)狀的調(diào)查統(tǒng)計,研究探尋影響藥液漏出的各種因素及其影響程度,針對性地實施干預(yù)措施,減少或避免藥液的漏出,使注入患者體內(nèi)的胰島素劑量與醫(yī)囑劑量相一致,保證臨床療效;同時摸索出更嚴謹科學的胰島素筆注射操作規(guī)程,供臨床同仁借鑒。方法:1.回顧性巢式病例對照研究:采用自制調(diào)查量表進行資料的收集(詳見附錄),包括:樣本人群的基本情況、疾病相關(guān)狀況和胰島素筆注射情況等。本調(diào)查采用整群抽樣方法,對2015年6月1日到2015年12月31日在皖南醫(yī)學院第一附屬醫(yī)院內(nèi)分泌科住院診治的92例符合納入條件的2型糖尿病患者進行了胰島素筆的規(guī)范化注射(每人注射3次),并觀察注射后有無藥液漏出,收集患者相關(guān)的臨床資料,對影響患者胰島素筆注射后藥物漏出的潛在因素進行單因素和多因素分析,探尋真正的影響因素,分析其影響程度。2.干預(yù)性研究:根據(jù)已確立的影響因素進行干預(yù),同樣采用整群抽樣的方法,對2016年1月1日到2016年10月30日在皖南醫(yī)學院第一附屬醫(yī)院內(nèi)分泌科住院診治的93例符合納入條件的2型糖尿病患者進行了胰島素筆的規(guī)范化注射(每人注射3次),在固定注射后針頭停留皮下時間(t=15s)的情況下,觀察注射12個不同劑量胰島素(4u、6u、···、26U)后藥液漏出的情況,收集患者相關(guān)的臨床資料,將其漏液發(fā)生的陽性率與基線調(diào)查進行對比分析。結(jié)果:1.回顧性巢式病例對照研究:本次調(diào)查的2型糖尿病患者胰島素筆注射后藥液漏出的現(xiàn)象較為普遍,一共對符合條件的92例患者進行了規(guī)范化的胰島素筆注射276人次,觀察注射后發(fā)生漏液的為158例次,漏液發(fā)生率約為57.2%;尤其是當注射劑量較大時,其發(fā)生比例更高。單因素分析結(jié)果顯示:胰島素筆注射后皮下停留時間(χ2=8.984,P0.05),在0.05水平上是顯著的;二分類Logistic回歸模型分析結(jié)果顯示:2型糖尿病患者胰島素筆的注射劑量(χ2=17.874,P0.05)和胰島素筆注射后皮下停留時間(χ2=21.581,P0.05)均有顯著性;并ROC曲線進一步分析皮下停留時間,得到臨界值(cut-off值),即當皮下停留時間為14.5秒時,漏液的發(fā)生率出現(xiàn)了折點改變。2.干預(yù)研究:本次研究納入了胰島素皮下注射常用的7個劑量的胰島素進行實驗,共93位患者,規(guī)范化胰島素筆注射279人次,其漏液發(fā)生率為20.1%,與干預(yù)前這七個不同單位胰島素注射時的漏液發(fā)生率66.4%相比,下降了3倍。且在當皮下停留時間為15s,胰島素的皮下注射劑量超過20u時,漏液的發(fā)生率接近于100%。結(jié)論:胰島素筆注射后針尖在皮下的停留時間以及注射劑量是影響胰島素筆注射后藥液漏出的影響因素,其中注射后針尖在皮下的停留時間是胰島素筆注射后藥液漏出的保護因素胰島素筆注射后皮下停留至少15s;劑量是危險因素,皮下注射胰島素劑量不易超過20u;可有效避免或減少胰島素注射后藥液的漏出。
[Abstract]:Objective: to investigate the current situation of drug leakage after insulin pen injection, to explore the factors affecting the leakage and the degree of influence, and to carry out intervention measures to reduce or avoid the leakage. The dose of insulin injected into the body of patients is consistent with the prescribed dose, and the clinical efficacy is guaranteed. At the same time, a more rigorous and scientific procedure for the injection of insulin pen is found, which can be used for reference by the clinical colleagues. Method 1: 1. Retrospective nested case-control study: a self-made questionnaire was used to collect data (see appendix for details), including: the basic situation of the sample population, disease related status and insulin pen injection. Cluster sampling was used in this survey. From June 1, 2015 to December 31, 2015, 92 patients with type 2 diabetes mellitus who were admitted to the Department of Endocrinology, the first affiliated Hospital of Southern Anhui Medical College, were given a standardized injection of insulin pen. And to see if there was any leakage after the injection, The clinical data of patients were collected and the potential factors of drug leakage after insulin pen injection were analyzed by univariate and multivariate analysis to find out the real influencing factors and to analyze the degree of influence. 2. Interventionist study: intervention based on established influencing factors, as well as cluster sampling, From January 1, 2016 to October 30, 2016, 93 patients with type 2 diabetes mellitus who were admitted to the Department of Endocrinology, the first affiliated Hospital of Southern Anhui Medical College, were given a standardized injection of insulin pen. When the needle stays subcutaneously after the injection (t0. 15 s), The leakage of 12 different doses of insulin (4U, 6u, 26U) was observed, and the clinical data of the patients were collected, and the positive rate of the leakage was compared with the baseline investigation. The result is 1: 1. Retrospective nested case-control study: the drug leakage after insulin pen injection was common in type 2 diabetes mellitus patients, and a total of 276 standardized insulin pen injections were performed on 92 patients who met the criteria. 158 cases of leakage occurred after injection, the rate of leakage was about 57.2, especially when the injection dose was high, the proportion of leakage was higher. The results of univariate analysis showed that the time of subcutaneous residence after insulin pen injection (蠂 2 + 8.984) was significant at the level of 0.05; The results of logistic regression analysis showed that the injection dose of insulin pen (蠂 2 + 17.874) and the subcutaneous residence time (P 0.05) after injection of insulin pen were significant in patients with type 2 diabetes mellitus, and the ROC curve was used to further analyze the subcutaneous residence time. The critical value (cut-off) is obtained, that is, when the subcutaneous residence time is 14. 5 seconds, the rate of leakage changes by 0. 2. Intervention study: this study included 7 doses of insulin commonly used for subcutaneous insulin injection. A total of 93 patients were given a standardized insulin pen 279 times. The rate of leakage was 20.1%, which was three times lower than that of the seven units of insulin injection before intervention (66.4%). When the subcutaneous residence time was 15 s and the subcutaneous injection dose of insulin was more than 20 u, the rate of leakage was close to 100. Conclusion: the retention time of the tip of the needle after insulin pen injection and the injection dose are the influencing factors for the leakage of the drug after insulin pen injection. The retention time of the tip of the needle in the skin after injection is the protective factor of the leakage of the liquid after the injection of the insulin pen; the dosage is the risk factor, and the stay under the skin after the injection of the insulin pen is at least 15 s. Subcutaneous injection of insulin is not easy to exceed 20 u. it can effectively prevent or reduce the leakage of the drug after insulin injection.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

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