基于跨理论模型的认知干预在2型糖尿病合并轻度认知功能障碍患者中的应用研究

发布时间：2018-05-07 02:27

本文选题：跨理论模型 + 2型糖尿病　；参考：《南京中医药大学》2016年硕士论文

【摘要】：[目的]探讨基于跨理论模型的认知干预模式在2型糖尿病合并轻度认知功能障碍患者中应用的可行性与有效性,通过对患者所处的认知行为阶段的评估,给予该阶段相匹配的认知干预,旨在降低患者的认知功能障碍程度,提高其日常生活活动能力、糖尿病自我管理能力,最终达到促进患者建立良好的健康行为,降低并发症,提高生活质量的目的。[方法]前瞻性随机对照研究,选择2014年01月至2015年06月入住南京鼓楼医院老年科的120例2型糖尿病合并轻度认知功能障碍患者,计算机生成随机号,装入不透光的密闭信封,尾数单号为对照组(n=60),尾数双号为实验组(n=60)。对照组给予常规认知干预,包括记忆能力训练、空间障碍训练、逻辑能力障碍训练、运算能力训练、日常生活能力训练等项目；实验组实施基于跨理论模型的认知干预,对患者所处的认知行为阶段进行评估,给予相匹配的认知干预。在干预前、干预后1个月、3个月和6个月分别评估认知训练行为变化阶段、认知功能状态(简易精神状态检查表)、日常生活活动能力(Barthel指数)、糖尿病自我管理能力(糖尿病自我管理能力量表)、餐后2h血糖及糖化血红蛋白等指标。[结果]1.两组研究对象一般人口学资料进行比较：包括年龄、性别、职业、婚姻状况、文化程度、家庭月收入、医疗费用来源、居住方式、照顾者、病程及发生低血糖的次数共11个项,差异均无统计学意义(P0.05),具有可比性。2.两组研究对象认知训练行为改变阶段比较,在干预前和干预后1个月时差异无统计学意义(P0.05),干预3个月和干预6个月时有统计学意义(P0.05)3.两组研究对象认知功能及日常生活活动能力进行比较,在干预前和干预后1个月时两组MMSE及Barthel指数量表得分差异无统计学意义(P0.05),干预3个月和干预6个月时实验组优于对照组,差异有统计学意义(P0.05)；4.两组研究对象糖尿病自我管理能力及血糖控制指标进行比较,在于预前和干预后1个月时两组DSCS、2hPBG及Hb值差异无统计学意义(P0.05),干预3个月和干预6个月时实验组优于对照组,差异有统计学意义(P0.05)。[结论]基于跨理论模型的认知干预模式可以促进2型糖尿病合并轻度认知功能障碍患者的认知训练行为的转变,降低干预过程中的退出率,同时可以更好地改善2型糖尿病合并轻度认知功能障碍患者的认知水平、糖尿病自我管理能力及血糖控制水平,适合在临床上推广使用。
[Abstract]:[objective] to explore the feasibility and effectiveness of cognitive intervention model based on cross-theoretical model in patients with type 2 diabetes mellitus with mild cognitive impairment, and to evaluate the cognitive behavior stage of patients with type 2 diabetes mellitus. In order to reduce the degree of cognitive dysfunction, improve the ability of daily life and self-management of diabetes mellitus, the cognitive intervention can promote the patients to establish good healthy behavior and reduce the complications. The purpose of improving the quality of life. [methods] A prospective randomized controlled study was conducted in 120 patients with type 2 diabetes mellitus complicated with mild cognitive impairment who were admitted to the Geriatrics Department of Nanjing Gulou Hospital from January 2014 to June 2015. The Mantissa single number was the control group, and the Mantissa number was the experimental group. The control group was given routine cognitive intervention, including memory training, spatial disorder training, logic disorder training, arithmetic training and daily living ability training, while the experimental group was given cognitive intervention based on cross-theoretical model. The cognitive behavior stage was evaluated and matched cognitive intervention was given. Before intervention, 1 month, 3 months and 6 months after intervention, cognitive training behavior changes were evaluated, respectively. Cognitive function (simple mental state examination table, activity of daily living (ADL) and Barthel index), diabetes self-management ability (diabetes self-management ability scale), 2 h postprandial blood glucose and glycosylated hemoglobin, and so on. [result] 1. The data of general demography were compared between the two groups: age, sex, occupation, marital status, education, monthly income of family, source of medical expenses, living style, caregivers, course of disease and frequency of hypoglycemia were 11 items. The differences were not statistically significant (P 0.05), and were comparable. There was no significant difference in cognitive training behavior between the two groups before and 1 month after intervention, but there was significant difference between the two groups at 3 months and 6 months. Cognitive function and activity of daily living (ADL) were compared between the two groups. There was no significant difference in the scores of MMSE and Barthel index between the two groups before and 1 month after intervention. The experimental group was superior to the control group at 3 months and 6 months of intervention. The difference was statistically significant (P 0.05). The diabetic self-management ability and blood glucose control index were compared between the two groups. The results showed that there was no significant difference in PBG and HB between the two groups before and 1 month after intervention. The experimental group was superior to the control group at 3 months and 6 months of intervention. The difference was statistically significant (P 0.05). [conclusion] the cognitive intervention model based on cross-theoretical model can promote the change of cognitive training behavior in patients with type 2 diabetes mellitus with mild cognitive impairment, and reduce the withdrawal rate during the intervention process. At the same time, it can improve the cognitive level of type 2 diabetes mellitus patients with mild cognitive dysfunction, diabetes self-management ability and blood glucose control level, which is suitable for clinical use.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.5

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