運(yùn)動(dòng)結(jié)合心理療法對(duì)2型糖尿病患者血糖水平的影響

1、運(yùn)動(dòng)結(jié)合心理療法對(duì)2型糖尿病患者血糖水平的影響中國(guó)臨床康復(fù)第9卷第,J朋2005.08.21出版ChineseJournalofClinicalRehabilitation,Augttst212005Vo1.9No.31運(yùn)動(dòng)結(jié)合心理療法對(duì)2型糖尿病患者血糖水平的影響李秀珍?臨床研究?焦作煤業(yè)集團(tuán)中央醫(yī)院二分院內(nèi)二科,河南省焦作市454ooO李秀珍,女,1962年生,山東省臨清市人,漢族,1997年河南醫(yī)科大學(xué)畢業(yè),主要從事內(nèi)科護(hù)理及管理方面的工作.dj0012sina.con中圖分類號(hào):R587.1文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):16715926(2005)31-004002收稿Et期:2005031

2、6修回日期:200505一l1(01/NG/YH)InfluenceofexercisetherapyCOITIbinedwithpsychotherapyonthelevelofplasmaglucoseinpatientswithtype2diabetesLiXiuzhen.SecondDepartmentofInternalMedicine,SecondDivisionofCentralHospitalofJiaozuoCoalCo.1ad.Jiaozuo454ooO.HenanProvince,ChinaLiXiu-zhen,SecondDepartmentofInternalMedi

3、cine.SecondDivisionofCentralHospitalofJiaozuoCoalCo.Ltd.Jiaozuo454ooO.HenanPrprince.Chinadi0ol2sina.conReceived:200503一】6Accepted:2005-05】AbstractA:Toinvestigatethechangesofplasmaglucoseintype2diabeticpatientsbeforeandafterexercisetherapypluspsychotherapy.M匱TH0DS:FromJanuary2003toDecember20o4.150pat

4、ientswithdiabeteswereselectedfrontheinpatientsintheSecondDepartmentofInternalMedicine.SecondDivisionofCentralHospitalofJiaozuoCoalCo.Ltd.andallofthemwereinformedconsent.Aceordjngtotheirhospitalizationorder,the9weredividedinipexperimentgroup(n=901andcontrolgroup(n=60)Patientsintheeontrolgrpupreceived

5、routinetreatment.e.drugtreatmentplustrophotherapy.andthoseintheexperimentreceivedexercisetherapypluspsychotherapybesidestheroutinetreatment.(1Exercisetherapy:Stroll,medicaltreatmentonfoatandioggingwerecombinedorganicallyastheroutineexerciseitems.Strollwasinaslowspeedwhenthewholebodywasrelaxedforl0t0

6、30minutes.Themedicaltreatmentonfootwasplanned1oprolongthedistancegradually.jncreasethewalkingspeedandthenaddclimbingslopeorstepeverydayoronceeveryanotherday.Joggingwasproperwhenthepatientswerealittlepantingbutstillabletotalkingfor5minutesinthebeginningandthenlongergradually.Psychotherapy:Relaxingexe

7、rcisewasperformed20minutesonceperday;Supportivepsychotherapy.akindofmentalhealtheducation.wasper.formed32timesaweek,30to45minutesonce;Musictherapywas30minutesperday.Theabovetreatmentwasallperformed4weeksasacourseforatotalof2courses.Thepatientsbiochemicalindexeswerede.tectedbeforetreatmentand2courses

8、aftertreatment.Criteriafortherapeu.ticeffect:Remarkableeffectwasbasedonthesymptomsdisappearingnear.1y,theleveloffastingplasmaglucosefrPG1lowerthan7.2mmol/L.thelevelof2-hourplasmaglucoselowerthan8.3mmol/L,thequantitativecontentof24一hoururineglucoselessthan10,8gorthelevelofplasmaglucoseat24.hoururineg

9、lucosedecreasedbyhigherthan30%ascon.parewithbeforetreatment;Vvedobviouslyaftertreatment.thelevelofFPGlowerthan8.3mmol/Lthelevelof2.hourplasmaglucoselowerthan100mmo1/L.thequantita.tivecontentof24.hoururineglucoselessthan25.8gorthelevelofplas.maglucoseat24-houru

10、rineglucosedecreasedbymorethan10%ascon.parewithbeforetreatment;Invaliditywasbasedonthesymptomsimprovedunremarkably.thelevelofplasmaglucoseorurineglucoselowerthantheabove.mentionedindexes.RESULTS:A1lthe150patientswereanalyzedintheresullwithoutlass.(I)InthecomparisonofFPGlevelbetweenthetwogroupsafter2

11、-coursetreat.ment:ThelevelofFPGwassignificantlyhigherintheexperimentgroupthaninthecontrolgroupI(6.99±1.35)mmol/Is(6.67±0.581mmol/L,f=1.963,P<0.051.(Inthecomparisonofquantitativecontentof24.hoururineglucosebetweenthetwogroupsafter2-coursetreatment:Itwassignificantlylessintheexperimen

12、tgroupthaninthecontrolgroup(0.620.31)g”s(1.020.49)g,t=3.298,P<0.01.Inthecomparisonofglycatedferrohemoglobinlevelbetweenthetwogroupsafter2.coursetreatment:Itwas.significantlylowerintheexperimentgroupthaninthecontrolgroup(6.690.96)%us(7.15±0.82)%,t=2.580,P<0.01.Inthecomparisonofeffe

13、ctiveratebetweenthetwogroupsafter2.coursetreat.ment:Itwassignificantlyhigherintheexperimentgroupthaninthecon.trolgroup(98%us76%,9.2l,P<0.01).C0NCLUS10N:Theexercisetherapypluspsychohherapyisthefurtherimprovementinthetreatmentofdiabetesmellitusinmodernmedicine.whichcancontroltheplasmaglucosebet

14、terandhasahiereffectiveratethanroutinetreatmenthas.Li)(zInfluenceofexercisetherapycombinedwithpsychotherapyonthelevelofplasmaglucoseinpotienlswith1ype2diabetesZhongguoLinchuang2005;9(311:40一l(ChinaJ李秀珍運(yùn)動(dòng)結(jié)合心理療法對(duì)2型糖尿病患者血糖水平的影l(fā)lJ1中國(guó)臨床康復(fù),2005,9(31):40-Ilwwwzglckf l摘要目的:觀察運(yùn)動(dòng)結(jié)合心理療法治療前后2型糖尿病患者血糖水平的變化情況.方法:

15、選擇20030l/20o4一l2在焦作煤業(yè)集團(tuán)中央醫(yī)院二分院內(nèi)分泌代謝病科就診的2型糖尿病患者150例,均知情同意.按人院順序分為2組,實(shí)驗(yàn)組90例,對(duì)照組60例.對(duì)照組只進(jìn)行常規(guī)治療,即藥物治療加飲食治療.實(shí)驗(yàn)組在常規(guī)治療的基礎(chǔ)上增加運(yùn)動(dòng)療法和心理療法.運(yùn)動(dòng)療法:將散步,醫(yī)療步行,慢跑有機(jī)結(jié)合作為常規(guī)項(xiàng)目.散步速度緩慢,全身放松,l030min/次;醫(yī)療步行按計(jì)劃逐漸延長(zhǎng)距離,提高步行速度以后可加入爬坡或登階運(yùn)動(dòng).每日或隔日進(jìn)行1次;慢跑以有輕度氣促,尚能交談為宜.從5min開(kāi)始,逐漸延長(zhǎng)持續(xù)時(shí)間.心理療法:放松訓(xùn)練20min/次,1次/d;支持性心理療法為心理健康教育,32次/周,3045

16、min/次;音樂(lè)治療2030min/次,1次/d.以上治療4周為1個(gè)療程,共2個(gè)療程.治療前檢測(cè)患者的空腹血糖,餐后2h血糖,糖化血紅蛋白水平及24h尿糖定量,治療后每周檢測(cè)1次.治療前后及治療2個(gè)療程后檢測(cè)患者各生化指標(biāo)的變化情況.療效判定標(biāo)準(zhǔn):顯效為治療后癥狀基本消失,空腹血糖<7.2mmol/L,餐后2h血糖<8.3mmol/L,24h尿糖定量<10.8g或血糖24h尿糖定量較治療前下降30%以上.有效:治療后癥狀明顯改善,空腹血糖<8.3mmol/L,餐后2h血糖<10.0mmol/L,24h尿糖定量<

17、25.8g或血糖24h尿糖定量較治療前下降l0%以上.無(wú)效:治療后癥狀無(wú)明顯改善,血糖,尿糖下降未達(dá)到上述指標(biāo).結(jié)果:150例患者全部進(jìn)入結(jié)果分析,無(wú)脫落.兩組患者治療2個(gè)療程后空腹血糖水平的比較:實(shí)驗(yàn)組高于對(duì)照組【(6.99+1.35,6.67i-0.58)inlnol,(t=1.963,P<0.05).兩組患者治療2個(gè)療程后24h尿糖定量的比較:實(shí)驗(yàn)組顯著低于對(duì)照組(0.620.3l,1.020.49)g,(f:3.298,P<0.01)1.兩組患者治療2個(gè)療程后糖化血紅蛋白水平的比較:實(shí)驗(yàn)組顯著低于對(duì)照組(6,69+0.96)%,(7.150.82)%(t=2

18、.580,P<0.01)1.(兩組患者治療2個(gè)療程后的有效率比較:實(shí)驗(yàn)組顯著高于對(duì)照組【98%,76%(XU9.21,P<0.01).結(jié)論:運(yùn)動(dòng)結(jié)合心理療法是現(xiàn)代醫(yī)學(xué)治療糖尿病的進(jìn)一步完善,該療法體現(xiàn)出的良好的血糖控制作用,治療有效率顯著優(yōu)于常規(guī)療法.主題詞:糖尿病,非胰島素依賴型;血糖;運(yùn)動(dòng)療法;心理療法0引言糖尿病目前仍以綜合治療為主,飲食與藥物治療雖已受到相當(dāng)?shù)闹匾?但患者需長(zhǎng)期服藥,而且對(duì)并發(fā)癥的控制和預(yù)防效果較差.本文主要探討運(yùn)動(dòng)和心理療法有機(jī)結(jié)合治療對(duì)2型糖尿病患者的干預(yù)作用,并觀察治療前后患者血糖的變化情況.1對(duì)象和方法設(shè)計(jì):自身前后對(duì)照觀察.單位:焦

19、作煤業(yè)集團(tuán)中央醫(yī)院二分院內(nèi)分泌代謝病科:選擇200301/200412在焦作煤業(yè)集團(tuán)中央醫(yī)院二分院內(nèi)分泌代謝病科就診的2型糖尿病患者150例.納入標(biāo)準(zhǔn):肥胖型,病情處于穩(wěn)定期自愿參加本觀察.排除標(biāo)準(zhǔn):伴有嚴(yán)重并發(fā)癥者.150例患者中男63例,女87例,年齡36-65歲,病程0.5-15年,住院75例,門診4O例.IssN1671-5926CN211470/Rw.:comkf23385083sina 李秀珍運(yùn)動(dòng)結(jié)合心理療法對(duì)2型糖尿病患者血糖水平的影響設(shè)計(jì),實(shí)施,評(píng)估者:設(shè)計(jì)為本文作者,運(yùn)動(dòng)和心理療法的實(shí)施及資料收集,生化指標(biāo)監(jiān)測(cè)為經(jīng)過(guò)相應(yīng)培訓(xùn)的內(nèi)分泌代謝科和檢驗(yàn)科的醫(yī)護(hù)人員,實(shí)驗(yàn)過(guò)程未采用盲法

20、評(píng)估.方法:將人選病例按人院的先后順序分為2組,實(shí)驗(yàn)組90例,對(duì)照組60例.對(duì)照組只進(jìn)行常規(guī)治療,即藥物治療加飲食治療.實(shí)驗(yàn)組在常規(guī)治療的基礎(chǔ)上增加運(yùn)動(dòng)療法和心理療法.運(yùn)動(dòng)療法:本觀察將散步,醫(yī)療步行,慢跑有機(jī)結(jié)合作為常規(guī)項(xiàng)目.散步:因運(yùn)動(dòng)強(qiáng)度小,主要用于精神和肌肉的放松,安排在優(yōu)美的環(huán)境里進(jìn)行,一般速度緩慢,全身放松,每次持續(xù)1030min.醫(yī)療步行:在平地或適當(dāng)?shù)钠律献鞫ň嚯x,定速的步行,中途作必要的休息.按計(jì)劃逐漸延長(zhǎng)步行距離(如自l500in至4000m),提高步行速度(如以20rain至16min走完1000in)以后可加入一定距離的爬坡或階運(yùn)動(dòng).每日或隔日進(jìn)行1次.可根據(jù)環(huán)境條件及

21、患者的具體情況設(shè)計(jì)不同運(yùn)動(dòng)量的方案.慢跑:運(yùn)動(dòng)強(qiáng)度較大,適用于年齡不太大,心血管功能較好,有一定鍛煉基礎(chǔ)或體形肥胖的患者.可以從5min開(kāi)始,逐漸延長(zhǎng)每次慢跑的持續(xù)時(shí)間.心理療法:放松訓(xùn)練:即通過(guò)一定的程式訓(xùn)練達(dá)到精神或軀體上(骨骼肌)放松的一種行為治療方法.放松訓(xùn)練20min/次,1次/d.支持性心理療法:舉辦糖尿病知識(shí)講座,耐心聽(tīng)取患者傾訴,啟發(fā)誘導(dǎo),32次/周,3045min/次.音樂(lè)治療:2030min/次,1次/d.將音樂(lè)錄音,供患者在家隨時(shí)治療.4周為1個(gè)療程,全部病例均治療2個(gè)療程.治療前檢測(cè)患者的空腹血糖,餐后2h血糖,糖化血紅蛋白水平及24h尿糖定量,治療后每周檢測(cè)1次.療效

22、評(píng)定標(biāo)準(zhǔn):顯效為治療后癥狀基本消失,空腹血糖<7.2mmol/L,餐后2h血糖<8.3mmol/L,24h尿糖定量<10.8g或血糖24h尿糖定量較治療前下降30%以上.有效:治療后癥狀明顯改善,空腹血糖<8.3mmol/L,餐后2h血糖<10.0mmol/L,24h尿糖定量<25.8g或血糖24h尿糖定量較治療前下降10%以上.無(wú)效:治療后癥狀無(wú)明顯改善,血糖,尿糖下降未達(dá)到上述指標(biāo).主要觀察指標(biāo):患者治療前及治療2個(gè)療程后的空腹血糖,餐后2h血糖,糖化血紅蛋白水平及24h尿糖定量.兩組患者治療2個(gè)療程后的有

23、效率比較.統(tǒng)計(jì)學(xué)分析:由作者采用SPSS10.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,兩組問(wèn)的比較應(yīng)用t檢驗(yàn)及方差分析.2結(jié)果2.1參與者數(shù)量分析納入2型糖尿病患者150例,全部進(jìn)入結(jié)果分析,無(wú)脫落.2.2統(tǒng)計(jì)推斷2.2.1兩組患者治療前及治療2個(gè)療程后各生化指41標(biāo)比較見(jiàn)表1.表1兩組患者治療前及治療2個(gè)療程后各生化指標(biāo)比較()與治療前比較,牝1.989.P<0.05,bt=2.496-3.825,P<0.Ol;與對(duì)照組比較,:1.963P<0.05,at=3.298,2.580.P<0.0l如表l所示,與治療前進(jìn)行自身對(duì)照比較,兩組患者治療2個(gè)療程后的各項(xiàng)生化指標(biāo)均顯著降低(P<0.05-4).O1).治療2個(gè)療程后,實(shí)驗(yàn)組患者的空腹血糖水平高于對(duì)照組(P<0.05),而實(shí)驗(yàn)組患者的24h尿糖定量及糖化血紅蛋白水平顯著低于對(duì)照組(P<0.01).2.2.2兩組