糖尿病患者胰岛素笔注射后漏液相关因素及其护理的研究

发布时间：2018-06-22 04:18

本文选题：糖尿病 + 胰岛素笔注射　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:通过对胰岛素笔注射后药液漏出现状的调查统计,研究探寻影响药液漏出的各种因素及其影响程度,针对性地实施干预措施,减少或避免药液的漏出,使注入患者体内的胰岛素剂量与医嘱剂量相一致,保证临床疗效;同时摸索出更严谨科学的胰岛素笔注射操作规程,供临床同仁借鉴。方法:1.回顾性巢式病例对照研究:采用自制调查量表进行资料的收集(详见附录),包括:样本人群的基本情况、疾病相关状况和胰岛素笔注射情况等。本调查采用整群抽样方法,对2015年6月1日到2015年12月31日在皖南医学院第一附属医院内分泌科住院诊治的92例符合纳入条件的2型糖尿病患者进行了胰岛素笔的规范化注射(每人注射3次),并观察注射后有无药液漏出,收集患者相关的临床资料,对影响患者胰岛素笔注射后药物漏出的潜在因素进行单因素和多因素分析,探寻真正的影响因素,分析其影响程度。2.干预性研究:根据已确立的影响因素进行干预,同样采用整群抽样的方法,对2016年1月1日到2016年10月30日在皖南医学院第一附属医院内分泌科住院诊治的93例符合纳入条件的2型糖尿病患者进行了胰岛素笔的规范化注射(每人注射3次),在固定注射后针头停留皮下时间(t=15s)的情况下,观察注射12个不同剂量胰岛素(4u、6u、···、26U)后药液漏出的情况,收集患者相关的临床资料,将其漏液发生的阳性率与基线调查进行对比分析。结果:1.回顾性巢式病例对照研究:本次调查的2型糖尿病患者胰岛素笔注射后药液漏出的现象较为普遍,一共对符合条件的92例患者进行了规范化的胰岛素笔注射276人次,观察注射后发生漏液的为158例次,漏液发生率约为57.2%;尤其是当注射剂量较大时,其发生比例更高。单因素分析结果显示:胰岛素笔注射后皮下停留时间(χ2=8.984,P0.05),在0.05水平上是显著的;二分类Logistic回归模型分析结果显示:2型糖尿病患者胰岛素笔的注射剂量(χ2=17.874,P0.05)和胰岛素笔注射后皮下停留时间(χ2=21.581,P0.05)均有显著性;并ROC曲线进一步分析皮下停留时间,得到临界值(cut-off值),即当皮下停留时间为14.5秒时,漏液的发生率出现了折点改变。2.干预研究:本次研究纳入了胰岛素皮下注射常用的7个剂量的胰岛素进行实验,共93位患者,规范化胰岛素笔注射279人次,其漏液发生率为20.1%,与干预前这七个不同单位胰岛素注射时的漏液发生率66.4%相比,下降了3倍。且在当皮下停留时间为15s,胰岛素的皮下注射剂量超过20u时,漏液的发生率接近于100%。结论:胰岛素笔注射后针尖在皮下的停留时间以及注射剂量是影响胰岛素笔注射后药液漏出的影响因素,其中注射后针尖在皮下的停留时间是胰岛素笔注射后药液漏出的保护因素胰岛素笔注射后皮下停留至少15s;剂量是危险因素,皮下注射胰岛素剂量不易超过20u;可有效避免或减少胰岛素注射后药液的漏出。
[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.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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