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目的探讨应用胰岛素泵治疗1型糖尿病(T1DM)患儿不同依从性的原因与对策。方法对2000年1月-2008年12月在天津市儿童医院收治的T1DM患者278人次,采用自行设计的T1DM胰岛素泵治疗调查问卷,分析影响糖尿病患者胰岛素治疗依从性的原因,并探讨相应的对策。结果T1DM患者278人次中,85.25%(237人次)同意胰岛素泵治疗,14.75%(41人次)拒绝胰岛素泵治疗。<3岁患者中58.33%(21人次)同意胰岛素泵治疗,>3岁患者中89.26%(216人次)同意胰岛素泵治疗,差异有统计学意义(χ2=23.83,P<0.01);第1次接触胰岛素泵者208人次中82.69%(172人次)同意胰岛素泵治疗,曾使用胰岛素泵或是否接触过使用胰岛素泵的患者中92.86%(65人次)同意胰岛素泵治疗,差异有统计学意义(χ2=4.30,P<0.05)。同意胰岛素泵治疗者与拒绝胰岛素泵治疗者对T1DM的认识得分(t=2.11,P<0.05)和对胰岛素泵的认识得分(t=10.53,P<0.01)的差异均有统计学意义。在治疗过程中由同意改为拒绝胰岛素泵治疗的主要原因为患者有异物感、使用过程中出现故障、发生低血糖;由拒绝改为同意的主要原因:未用胰岛素泵的情况下血糖控制不理想,同时住院的应用胰岛素泵的患者与之交流,期望血糖得到更好的控制。结论健康教育、心理行为干预、使用指导、疗效对比、正规熟练的操作可提高治疗的依从性。
Objective To investigate the causes and countermeasures of different adherences of insulin pump for type 1 diabetes (T1DM) in children. Methods A total of 278 T1DM patients admitted to Children’s Hospital of Tianjin from January 2000 to December 2008 were enrolled in this study. The self-designed T1DM insulin pump was used to treat the questionnaire and analyze the reasons that influence the adherence of insulin therapy in diabetic patients and the corresponding countermeasures . Results Of the 278 patients with T1DM, 85.25% (237) agreed to receive insulin pump therapy and 14.75% (41) refused to receive insulin pump therapy. In the 3-year-old group, 58.33% (21) agreed to the insulin pump treatment, and 89.26% (216) in the 3-year-old agreed with the insulin pump treatment, the difference was statistically significant (χ2 = 23.83, P <0.01) 82.69% (172) of the 208 people who contacted the insulin pump agreed with the insulin pump treatment, 92.86% (65) of the patients who had used the insulin pump or had been exposed to the insulin pump agreed with the insulin pump treatment, the difference was statistically significant (χ2 = 4.30, P <0.05). There was a statistically significant difference between T1DM awareness score (t = 2.11, P <0.05) and recognition of insulin pump (t = 10.53, P <0.01) for insulin pump and insulin pump. In the course of treatment by the consent of the main reason for refusing insulin pump treatment for patients with foreign body sensation, the use of the process of failure, the occurrence of hypoglycemia; refused to agree to the main reason: without insulin pump control of blood sugar is not Ideal, at the same time hospitalized patients with insulin pump to communicate with them, expecting better control of blood sugar. Conclusion Health education, psychological behavior intervention, guidance, efficacy comparison, regular skilled operation can improve the treatment compliance.