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目的 评价"四位一体"营养管理模式在儿童1型糖尿病的治疗效果.方法 2011年3月至2013年6月在天津市儿童医院住院确诊为1型糖尿病患儿90例,采用分段均衡随机法产生随机数码表,通过随机信件将患儿分为干预组和对照组各45例,干预组采用"四位一体"营养管理模式,对照组采用传统的营养教育方法.观察期为1年.在住院期间和出院后1年对患儿进行"四位一体"营养管理干预,评价干预前后患儿父母对食物选择的变化情况、患儿对营养治疗的依从性、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平及发生并发症等情况.结果 干预后1年,干预组家长选择血糖生成指数较低的食物(41/45)、每天吃蔬菜水果(40/45)、经常食用豆制品(41/45)和不喝碳酸饮料(43/45)的比例均高于对照组(21/45、20/45、19/45、26/45)(P均<0.001);干预组患儿饮食治疗依从性明显好于对照组(P=0.000 2);两组患儿FPG、2 hPG、HbA1c均较干预前下降,干预组FPG[(8.11±2.82)mmol/L]、2 hPG[(12.82±1.05)mmol/L]、HbA1c[(6.10±0.93)%]均低于对照组[(11.71± 2.75)mmol/L、(13.77±1.49)mmol/L、(9.02±0.93)%;t=6.13、1.66、14.89,P均<0.001];干预后,干预组急性酮症酸中毒及低血糖发作14例,对照组39例发作,两组比较差异具有统计学意义(P=0.000 00).干预组再住院11例,对照组33例,差异有统计学意义(P=0.000 00).结论 "四位一体"营养管理模式对治疗儿童1型糖尿病有一定效果.

Objective To evaluate the effectiveness of"four in one"nutrition management mode in the treatment of type 1 diabetes mellitus (T1DM) in children. Methods Ninety children diagnosed with T1DM in Tianjin Children's Hospital were selected during March 2011 to June 2013. Segmented balanced random method was used to generate a random number timer, and the children were divided into intervention group and control group (n=45) by random letters. The patients in the intervention group were treated with"Four in one" nutrition management. Those in the control group were treated with traditional nutrition education method. Observation period was one year. The change of food choices of the parents was assessed before and after the intervention. Nutritional treatment compliance of children,fasting plasma glucose (FPG),2 hours postpransial glucose (2 hPG),and hemoglobin A1c (HbA1c) levels and complications, and so on were also evaluated. Results One year after intervention, the percentages of parents who chose low glycemic index food (41/45), vegetables and fruits consumed every day (40/45), often ate soy products(41/45), did not drunk carbonated drinks (43/45) of treatment group were significantly higher than those of control group (24/45, 20/45, 19/45, 26/45, P all<0.001);diet treatment compliance of children in treatment group was significantly better than that of the control group (P=0.000 2);FPG, 2 hPG, HbA1c of two groups of children decreased significantly than before. FPG[(8.11 ± 2.82) mmol/L], 2 hPG [(12.82 ± 1.05) mmol/L], HbA1c [(6.10±0.93)%] of treatment group were significantly lower than those of the control group [(11.71± 2.75) mmol/L, (13.77±1.49) mmol/L, (9.02±0.93)%;t=6.13, 1.66, 14.89;P<0.001 for all comparisons]. After treatment, 14 cases of treatment group had acute ketoacidosis and hypoglycemia , while 39 cases of control group had these complications (P=0.000 00). Readmission occurred in 11 cases of treatment group and 33 of the control group (P=0.000 00). Conclusions "Four in one"nutrition management mode was effective in the management of children with T1DM.