發(fā)布時間：2018-05-25 21:41

  本文選題：糖尿病 + 血糖管理　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評價基于醫(yī)院床邊血糖監(jiān)測系統(tǒng)(BGMS)數(shù)據(jù)調(diào)整血糖管理策略,對改善住院糖尿病患者血糖管理質(zhì)量的價值。方法:對2008-2011和2014-2015年在內(nèi)分泌科住院的3432例次和1292例次糖尿病患者及其196781次和64330次的BGMS血糖數(shù)據(jù),采用Population(群體模型)、Patient(個體模型)、Patient-day(人時模型)及質(zhì)量血糖評分模型(QHS)等多種血糖評價模型進(jìn)行分析和比較。結(jié)果:基于2008-2011年BGMS血糖數(shù)據(jù)分析結(jié)果,2013年開始對血糖監(jiān)測方式、睡前血糖目標(biāo)等血糖管理策略進(jìn)行調(diào)整后,與2008-2011年相比,2014-2015年住院糖尿病患者:①患者平均住院天數(shù)減少0.95天(10.62±6.69vs 11.57±6.62,p0.001),人均監(jiān)測血糖減少 7.55次(49.79±27.94 vs 57.34±31.31,p0.001),患者日均監(jiān)測血糖減少0.43次(5.05±2.00 vs 5.48±2.05,p0.001);②凌晨、午餐前等低血糖高發(fā)時間段的血糖監(jiān)測次數(shù)分別增加 32.11%(11.72%vs 8.71%,p0.001)和 12.15%(11.72%vs 10.45%,p0.001),而午餐后、晚餐后等低血糖低發(fā)時間段的血糖監(jiān)測次數(shù)則明顯減少(p0.05);③低血糖和嚴(yán)重低血糖事件頻次分別減少7.63%(1.09%vs 1.18%,p=0.051)和18.75%(0.13%vs 0.16%,p=0.073);發(fā)生低血糖和嚴(yán)重低血糖的患者比例分別下降13.37%(27.01%vs 31.18%,p=0.005)和 33.48%(4.65%vs 6.99%,p=0.003);低血糖和嚴(yán)重低血糖的患者-住院日分別減少 14.16%(4.97%vs 5.79%,p=0.001)和 24.71%(0.64%vs 0.85%,p=0.020);反復(fù)發(fā)生低血糖(3次)患者占總患者比例降低37.14%(2.86%vs 4.55%,p=0.009);④午餐前、午餐后、晚餐前、睡前時段的低血糖發(fā)生密度分別下降32.98%(1.26%vs 1.88%,p0.001)、44.29%(0.39%vs 0.70%,p=0.004)、32.53%(0.56%vs 0.83%,p=0.007)和 36.96%(0.58%vs 0.92%,p=0.001),早餐后、午餐前、午餐后、晚餐前及睡前時段發(fā)生低血糖的患者占比分別下降25.83%(5.11%vs 6.89%,p=0.027)、29.89%(6.59%vs 9.40%,p=0.003)、57.29%(1.67%vs 3.91%,p0.001)、29.05%(4.20%vs 5.92%,p=0.021)和 36.99%(4.19%vs 6.65%,p=0.002);⑤相較于住院前期(入院前3天),住院后期(入院3天后)在低/高血糖程度及血糖波動等方面的改善更為明顯,QHS評分改善幅度增加;⑥凌晨、早餐前及午餐前時段仍是低血糖的高發(fā)時間段,午餐后和睡前時段仍是嚴(yán)重高血糖的高發(fā)時間段;⑦出現(xiàn)嚴(yán)重高血糖事件的患者比例與前相仿,但嚴(yán)重高血糖事件及其患者-住院日分別增加11.82%(8.61%vs 7.70%,p0.001)和 8.16%(24.51%vs 22.66%,p0.001);⑧ 1 型糖尿病及老年(≥60歲)患者的低血糖發(fā)生率較高,低血糖減少更多見于2型糖尿病、非老年人(≤59歲)及男性患者。結(jié)論:充分利用信息化BGMS數(shù)據(jù),定期分析評價臨床血糖管理效果,尋找血糖控制相關(guān)影響因素,改進(jìn)和調(diào)整臨床血糖管理策略,可顯著改善住院糖尿病患者血糖管理質(zhì)量。
[Abstract]:Objective: To evaluate the value of adjusting blood glucose management strategy based on hospital bedside blood glucose monitoring system (BGMS) data to improve the quality of blood glucose management in hospitalized diabetic patients. Methods: 3432 cases in the 2008-2011 and 2014-2015 years in the Department of Endocrinology and 1292 cases of diabetes mellitus and their 196781 and 64330 blood glucose data, using Populat The ion (group model), the Patient (individual model), the Patient-day (human time model) and the mass glucose score model (QHS) were analyzed and compared. Results: Based on the results of the 2008-2011 year BGMS blood glucose data analysis, the blood glucose management strategies, such as blood glucose monitoring formula and bedtime blood glucose target, were adjusted in 2013, and 2008-2 Compared with 011 years, 2014-2015 years of hospitalized diabetic patients: (1) the average hospitalization days were reduced by 0.95 days (10.62 + 6.69vs 11.57 + 6.62, p0.001), and the per capita blood sugar decreased by 7.55 times (49.79 + 27.94 vs 57.34 + 31.31, p0.001). The number of blood glucose monitoring times increased by 32.11% (11.72%vs 8.71%, p0.001) and 12.15% (11.72%vs 10.45%, p0.001), while after lunch, the number of blood glucose monitoring times decreased significantly (P0.05), and the frequency of hypoglycemia and severe hypoglycemia decreased by 7.63% (1.09%vs 1.18%, p=0.051) and 18.75% (0.13) after lunch. %vs 0.16%, p=0.073); the proportion of patients with hypoglycemia and severe hypoglycemia decreased by 13.37% (27.01%vs 31.18%, p=0.005) and 33.48% (4.65%vs 6.99%, p=0.003); patients with hypoglycemia and severe hypoglycemia were reduced by 14.16% (4.97%vs 5.79%, p=0.001) and 24.71% (0.64%vs 0.85%, p=0.020), and recurrent hypoglycemia (3 times). The proportion of total patients was reduced by 37.14% (2.86%vs 4.55%, p=0.009); (4) before lunch, before dinner, before dinner, the density of hypoglycemia decreased by 32.98% (1.26%vs 1.88%, p0.001), 44.29% (0.39%vs 0.70%, p=0.004), 32.53% (0.56%vs 0.83%, p= 0.007) and 36.96% (0.58%vs 0.92%, p=0.001), after breakfast, lunch, dinner before and before dinner, and Patients with hypoglycemia during the time of bedtime were reduced by 25.83% (5.11%vs 6.89%, p=0.027), 29.89% (6.59%vs 9.40%, p=0.003), 57.29% (1.67%vs 3.91%, p0.001), 29.05% (4.20%vs 5.92%, p=0.021) and 36.99% (4.19%vs 6.65%, p=0.002), compared to the early hospitalization (3 days before admission) and low / high blood sugar levels in the late hospitalization (hospitalized days after admission) and The improvement in blood glucose fluctuations was more obvious, and the QHS score was improved. 6. In the early hours of the morning, before and before lunch, the high incidence of hypoglycemia was still a high time period of high blood sugar after lunch and bedtime; and the proportion of patients with severe hyperglycemia was similar to those of the former, but the serious hyperglycemia events and their suffering were The hospitalization days increased by 11.82% (8.61%vs 7.70%, p0.001) and 8.16% (24.51%vs 22.66%, p0.001), and the incidence of hypoglycemia in patients with type 1 diabetes and old age (> 60 years old) was higher, and hypoglycemia decreased more in type 2 diabetes, non elderly (less than 59 years) and male patients. Conclusion: the information of information BGMS is fully utilized and periodic analysis of evaluation is made. In order to improve and adjust the clinical blood glucose management strategy, the quality of blood glucose management in hospitalized diabetic patients can be improved significantly.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

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