远程视频指导下的糖尿病足溃疡患者居家康复护理实践探索

王俊思 秦雯 白姣姣 明月 孙皎

摘 要 目的：探索远程视频指导下的糖尿病足溃疡患者居家康复护理实践的有效性。方法：选取2018年9月—2020年2月在复旦大学附属华东医院糖尿病足整合门诊就诊的36例糖尿病足溃疡患者，采用非同期对照，对照组为整合门诊伤口护理，干预组在接受糖尿病足整合团队综合治疗与护理后，经评估筛选后进行远程视频指导下的居家康复护理，比较两组康复治疗效果及费用。结果：两组间足溃疡愈合时间差异无统计学意义（P>0.05）；干预组平均费用为（1 170.00±381.84）元，远低于对照组的平均费用（7 230.00±1 719.03）元（P<0.05）；首诊时及康复后的Barthel指数评分组间差异均无统计学意义（P>0.05），组内差异有统计学意义（P<0.05）。结论：经评估筛选的糖尿病足溃疡患者通过远程视频指导进行居家康复护理，能够促进创面愈合，节省费用，减轻照顾负担，提高患者日常生活活动能力。

关键词 糖尿病足；远程医疗；视频指导；居家康复；康复护理

中图分类号：R587.2文献标志码：A 文章编号：1006-1533（2020）14-0026-04

Practical exploration of the home-based rehabilitation nursing for diabetic foot ulcer patients under the guidance of remote video

WANG Junsi， QIN Wen， BAI Jiaojiao， MING Yue， SUN Jiao

（Diabetic Foot Integration Clinic of Huadong Hospital affiliated to Fudan University， Shanghai 200040， China）

ABSTRACT Objective： To explore the effectiveness of home-based rehabilitation nursing for diabetic foot ulcer patients under the guidance of remote video. Methods： From September 2018 to February 2020， 36 patients with diabetic foot ulcers who were treated in the Diabetic Foot Integration Clinic of Huadong Hospital affiliated to Fudan University were enrolled， and non synchronous control was used， the control group received integrated out-patient wound care， after receiving comprehensive treatment and care from the diabetic foot integration team， the intervention group received home-based rehabilitation nursing under the guidance of remote video after evaluation and screening， and the rehabilitation effect and cost of the two groups were compared. Results： There was no significant difference in the healing time of foot ulcer between the two groups（P> 0.05）； the average cost of the intervention group was （1 170.00±381.84） Yuan， which was much lower than that of the control group （7 230.00±1 719.03） Yuan（P<0.05）； there was no significant difference in the Barthel index scores between the first visit and after rehabilitation（P>0.05）， and the difference within the group was statistically significant（P<0.05）. Conclusion： After evaluation and selection， diabetic foot ulcer patients who are given home-based rehabilitation nursing through remote video guidance can promote wound healing， save costs， reduce the burden of care， and improve the ability of daily activities of patients.

KEY WORDS diabetic foot； telemedicine； video guidance； home-based rehabilitation； rehabilitation nursing

糖尿病足是糖尿病患者因下肢远端神经异常和不同程度血管病变导致的足部感染、溃疡和（或）深层组织破坏[1]，是糖尿病严重的慢性并发症之一。随着糖尿病患病率逐年增加，糖尿病足的患病率也逐渐增加。全球糖尿病足溃疡的患病率为6.3%，我国50岁以上的糖尿病患者中糖尿病足发病率高达8.1%[2]。糖尿病足患者年死亡率高达11%，截肢患者更是高达22%。国内外研究表明，治疗糖尿病足花费巨大，约占整个糖尿病医疗费用的1/3[3-4]。糖尿病足治疗难度大，需要持续、长期护理，而由于医疗资源、经济等因素，患者住院治疗时间有限，家庭及社区是糖尿病足患者延续康复治疗的重要场所。本研究將基于互联网的远程视频居家康复指导应用于糖尿病足溃疡患者的护理实践中，旨在观察其康复效果及费用，现将结果报告如下。