【摘要】：目的:評估2型糖尿病患者的平衡功能,找出2型糖尿病患者平衡功能的主要影響因素。為醫(yī)護人員提供準確的跌倒風險評估,及時發(fā)現潛在的跌倒者,并結合患者的臨床特征,對患者采取有效的干預方法,提高2型糖尿病患者的平衡功能,降低跌倒發(fā)生率提供理論依據。方法:選取2016年2月~7月在河北省保定市第一中心醫(yī)院內分泌科住院的2型糖尿病患者294例,收集患者的年齡、性別、身高、體重、運動情況資料;治療用藥情況、有無高血壓、冠心病、骨質疏松癥,糖尿病并發(fā)癥;實驗室檢查結果包括空腹血糖、糖化血紅蛋白、總膽固醇、甘油三酯、空腹血清胰島素、血清25(OH)D3等。查閱病歷獲得相關疾病檢查及診斷資料,應用多普勒血流探測儀測量并計算出踝肱比;使用Tetrax平衡測量儀測量患者八個姿勢下的平衡參數,并生成跌倒指數。以跌倒指數作為因變量,以獨立樣本t檢驗和單因素方差分析有統(tǒng)計學意義的變量作為自變量進行多元回歸分析,分析這些自變量對跌倒指數的影響作用。結果:1.294例患者的跌倒指數從1~100,平均47.86±8.18,其中128例患者的跌倒指數從1~36,平均22.82±9.42,處于低度跌倒風險,166例患者的跌倒指數從37~100,平均67.48±21.57,處于中高度跌倒風險。2.獨立樣本t檢驗和單因素方差分析有統(tǒng)計學意義的變量是年齡(t=16.61,P0.001)、文化程度(F=3.169,P=0.025)、運動情況(t=-4.804,P0.001)、用藥治療情況(F=5.662,P=0.001)、高血壓(t=-2.686,P=0.008)、冠心病(t=-1.742,P=0.012)、病程(F=10.325,P0.001)、糖化血紅蛋白(t=-2.339,P=0.020)、糖尿病神經病變(t=-2.216,P=0.027)、糖尿病視網膜病變(t=-3.446,P=0.001)、糖尿病腎病(t=-3.556,P0.001)、糖尿病下肢血管病變(t=-3.281,P=0.001)。3.以跌倒指數作為因變量,用藥治療情況、運動情況、高血壓、文化程度、糖尿病視網膜病變、糖尿病腎病、糖尿病神經病變、糖尿病下肢血管病變、年齡、病程、冠心病、糖化血紅蛋白進入多元逐步回歸分析,結果運動情況(β=-0.320,P0.001)、年齡(β=0.220,P0.001)、糖尿病視網膜病變(β=0.160,P=0.005)、糖尿病腎病(β=0.156,P=0.007)、糖化血紅蛋白(β=0.143,P=0.012)、用藥治療情況(β=0.135,P=0.017)最終進入方程。R2顯示6個變量共同解釋了跌倒指數總變異的27.6%。變量對2型糖尿病患者跌倒指數的貢獻大小從高到低依次為運動情況、年齡、糖尿病視網膜病變、糖尿病腎病、糖化血紅蛋白、用藥治療情況。結論:運動情況、年齡、糖尿病視網膜病變、糖尿病腎病、糖化血紅蛋白、用藥治療情況是2型糖尿病患者平衡功能的主要影響因素。平衡功能障礙是內部因素和外部因素協(xié)同作用的結果。因此,患者可根據自身狀況選擇適宜的運動形式來提高平衡功能,積極控制血糖,在用藥過程中應該注意用藥安全,積極治療延緩并發(fā)癥出現,注意潛在的危險防止跌倒。
[Abstract]:Objective: to evaluate the balance function of type 2 diabetes mellitus and to find out the main influencing factors. In order to improve the balance function of patients with type 2 diabetes mellitus, we can provide an accurate assessment of fall risk for medical staff, find out potential falls in time, and take effective intervention to patients with type 2 diabetes combined with the clinical characteristics of the patients, so as to improve the balance function of patients with type 2 diabetes mellitus. To reduce the incidence of falls provides a theoretical basis. Methods: 294 patients with type 2 diabetes mellitus were selected from the Endocrinology Department of the first Central Hospital of Baoding City, Hebei Province from February to July 2016. The data of age, sex, height, weight and exercise were collected. Treatment, medication, hypertension, coronary heart disease, osteoporosis, diabetes complications; Laboratory results included fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, fasting serum insulin, serum 25 (OH) D 3 and so on. The ankle-brachial ratio was measured by Doppler blood flow detector, and the balance parameters of eight postures were measured by Tetrax balance meter, and the fall index was generated. The fall index was used as dependent variable, and the independent sample t test and single factor variance analysis were used as independent variables to carry out multivariate regression analysis to analyze the effect of these independent variables on fall index. Results: the fall index of 1.294 patients ranged from 1 to 100 (mean 47.86 鹵8.18). The fall index of 128 patients ranged from 1 to 36, with an average of 22.82 鹵9.42, which was at a low risk of falling. The fall index of 166 patients ranged from 37 to 100, with an average of 67.48 鹵21.57. At moderate height fall risk. 2. The independent sample t-test and univariate ANOVA were age (t 16.61), education level (F = 3.169), exercise (t = -4.804) and exercise status (t = 4.804 / P0.001). The course of treatment (FN 10.325 P0.001), glycosylated hemoglobin (TG-2.339U, P0.020), coronary heart disease (TV-1.742U, P0. 012), hypertension (tn-2. 686U, P0. 008), course of disease (FN 10. 325 P0. 001), hemoglobin glycosylated hemoglobin (tn)-2. 339U P0. 020), Diabetic neuropathy, diabetic retinopathy, diabetic nephropathy, diabetic lower extremity vasculopathy, diabetic neuropathy, diabetic retinopathy, diabetic nephropathy, and diabetic lower extremity vascular disease, respectively. P0. 001). With fall index as dependent variable, medication treatment, exercise, hypertension, education, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic lower extremity vascular disease, age, course of disease, coronary heart disease, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic lower extremity vascular disease, age, course of disease, coronary heart disease, The results of multiple stepwise regression analysis of glycosylated hemoglobin were as follows: exercise (尾 = -0.320), age (尾 = 0.220), diabetic retinopathy (尾 = 0.160), diabetic nephropathy (尾 = 0.156), diabetic retinopathy (尾 = 0.160), diabetic nephropathy (尾 = 0.156). P0. 007), glycosylated hemoglobin (尾 = 0. 143, P0. 012), drug treatment (尾 = 0. 135, P0. 017) finally entered the equation. R2 showed that 6 variables explained the total variation of fall index. The contribution of variables to the fall index of type 2 diabetes mellitus patients from high to low in order of movement, age, diabetic retinopathy, diabetic nephropathy, glycosylated hemoglobin, drug treatment. Conclusion: exercise, age, diabetic retinopathy, diabetic nephropathy, glycosylated hemoglobin and medication are the main factors influencing the balance function of type 2 diabetic patients. Balance dysfunction is the result of synergy between internal and external factors. Therefore, patients can choose appropriate exercise form according to their own conditions to improve the balance function, actively control blood sugar, should pay attention to drug safety, active treatment to delay the occurrence of complications, pay attention to potential dangers to prevent falls.
【學位授予單位】：河北大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

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