糖尿病合并肺结核患者饮食问题的循证护理

目的通过循证的方法为糖尿病合并肺结核患者的饮食问题提供科学的护理干预，从而提高糖尿病并存结核病患者的治疗效果和生存质量。方法确定护理问题为糖尿病合并结核病患者的饮食问题，在中国期刊全文数据库中进行检索，以“肺结核、糖尿病、营养、健康教育、饮食”为关键词，1992年1月-2004年6月的文献中检索到符合要求、设计合理的文献共26篇。评价者对试验的方法学质量及纳入标准的恰当程度进行了评价，对资料进行了提取，分析各试验干预措施的差异，当资料允许时计算出合并结果。26篇文献中，评价为1级证据8篇，2级2篇，3级4篇，4级10篇，5级2篇。结果根据系统评价的结果，认为：（1）两病并存应适当放宽饮食限制；（2）首选优质蛋白、含糖量低、高纤维素、高维生素的蔬果及乳类食品；（3）禁止食用或限制食用对结核病并存糖尿病病情及治疗有负面影响的食物；（4）对自控能力差或饮食习惯不良的患者，要根据患者的实际情况和接受能力，进行循环互动式健康教育。在循证护理过程中，注意结合患者的个体差异实施护理，取得了良好效果：95％患者饮食控制理想，87％胸片显示病灶吸收，62％血糖控制好，营养不良患者从38例减少至5例，治愈率为94％。结论通过引入循证证据对结核病并存糖尿病患者的饮食护理提供指导，疗效明显提高，循证护理是整体护理的深化，在人力资源许可的情况下，应大力推广循证护理方法。

The Evidence-based Diet Care of Diabetics Combined with Tuberculosis

Objective To find a scientific nursing intervention on diabetics combined with tuberculosis by way of evidence-based diet care so as to increase the therapeutic effect.Methods The care problem was certified as diet problem among diabetics combined with tuberculosis.Literature retrieval was conducted on CHKD Periodicals Databank,with "tuberculosis,diabetes mellitus,nutrition,health education,diet" as retrieval key wards.26 papers were sorted out from Jan.1992 to Jun.2004.The quality of methodology in the trials and standards for adoption were evaluated,data were collected and the differences in intervention were analyzed and the results on the combined data were worked out,if possible.Among the sorted 26 papers,8 were appraised with First Grade evidence,2 with Second Grade,4 with Third Grade and 10 with Fourth Grade and 2 with Fifth Grade.Results The systematic evaluation showed(1) limitation on diet can be narrowed if combination of the two diseases.(2) The diet should include quality protein,fruits and milk products with low sugar,high fibrin and rich vitamins.(3) The foods influencing the treatment of the two diseases should be forbidden.(4) For those patients with less self-control ability,circulative and reactive health education should be done.The practical nursing care was performed based on individual difference,with better effect: 95% of them were comfortable at controlling their diet,the foci were absorbed in 87% by thoracic X-ray examination,blood sugar was ideally contained in 62%,the cases with malnutrition were reduced from 38 to 5,with a heal rate of 94%.Conclusion The instruction over diabetics with tuberculosis by way of introduction of evidence-based nursing can achieve better therapeutic effect.Evidence-based nursing,as a further of holistic nursing,is a composition to clinical nursing.It should be advocated if possible in rich personnel.