CBL教育模式结合思维导图在2型糖尿病患者自行注射胰岛素中的应用

卢素娟; 丛文杰

doi:10.16766/j.cnki.issn.1674-4152.003962

CBL教育模式结合思维导图在2型糖尿病患者自行注射胰岛素中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003962

卢素娟,
丛文杰^,

温州医科大学附属第一医院老年科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2024KY150

详细信息

通讯作者:
丛文杰，E-mail：congwenjie2018@163.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2024-08-26
- 网络出版日期: 2025-06-30

Application of CBL education model combined with mind mapping in self-injection of insulin in T2DM patients

LU Sujuan,
CONG Wenjie^,

Department of Geriatrics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨案例教学法(CBL)结合思维导图对2型糖尿病(T2DM)患者自行注射胰岛素知识掌握、血糖等的影响，旨在提高健康教育质量。方法选取2022年1月—2024年1月于温州医科大学附属第一医院治疗的101例T2DM患者，采用随机数字表法将其分为对照组(51例，采用口头和宣传册的方式进行胰岛素注射教育)和试验组(50例，采用CBL教育模式结合思维导图的方式进行胰岛素注射教育)，教育时间3个月，比较2组胰岛素注射知识及技术掌握情况、血糖水平、不良反应发生率等。结果试验组干预后胰岛素注射知识的掌握情况优于对照组(P＜0.05)，注射技术掌握评分高于对照组(P＜0.05)，糖化血红蛋白[(5.68±1.14)% vs. (7.05±1.26)%]、空腹血糖[(6.77±1.25)mmol/L vs. (8.11±2.37)mmol/L]、餐后2 h血糖[(9.01±2.31)mmol/L vs. (10.58±2.57)mmol/L]均低于对照组(P＜0.05)，不良反应总发生率低于对照组(P＜0.05)。结论 CBL教育模式结合思维导图对T2DM患者自行注射胰岛素知识和技能掌握水平的提高、血糖控制及不良反应的预防有积极作用。
- 2型糖尿病 /
- 胰岛素 /
- 案例教学法 /
- 思维导图 /
- 注射技术 /
- 血糖
Abstract: Objective To explore the effects of case-based learning (CBL) combined with mind mapping on self-injection insulin knowledge and blood glucose in type 2 diabetes mellitus (T2DM) patients, aiming to improve the quality of health education. Methods A total of 101 patients with T2DM treated at the First Affiliated Hospital of Wenzhou Medical University from January 2022 to January 2024 were selected. They were randomly divided into a control group (51 cases, receiving insulin injection education through verbal instructions and brochures) and an experimental group (50 cases, receiving insulin injection education using the CBL education model combined with mind mapping). The education period lasted for 3 months. Insulin injection knowledge and skills, blood glucose level and incidence of adverse reactions were compared between the two groups. Results After intervention, the insulin injection knowledge of experimental group was better than that of control group (P < 0.05), and the score of injection technique mastery was higher than that of control group (P < 0.05). HbA1c [(5.68 ± 1.14) % vs. (7.05 ±1.26) %], fasting blood glucose [(6.77±1.25) mmol/L vs. (8.11±2.37) mmol/L], 2 h postprandial blood glucose [(9.01±2.31) mmol/L vs. (10.58±2.57) mmol/L] were lower than those of control group (P < 0.05). The overall incidence of adverse reactions was lower than that of the control group (P < 0.05). Conclusion CBL education model combined with mind mapping has positive effects on the improvement of self-injection insulin knowledge and skills, blood glucose control and prevention of adverse reactions in T2DM patients.
- Type 2 diabetes mellitus /
- Insulin /
- Case-based learning /
- Mind mapping /
- Injection technique /
- Blood glucose

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表 1 2组T2DM患者一般资料比较

Table 1. Comparison of general information between two groups in T2DM patients

组别	例数	性别(男性/女性，例)	年龄(x±s，岁)	受教育年限(x±s，年)	病程(x±s，年)
对照组	51	31/20	50.90±5.77	12.90±3.11	2.56±0.44
试验组	50	26/24	51.02±6.91	12.77±3.54	2.78±0.77
统计量		0.792^a	0.095^b	0.196^b	1.767^b
P值		0.373	0.925	0.845	0.080
注：^a为χ²值，^b为t值。

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表 2 “走出胰岛素注射误区”主题思维导图内容

Table 2. Contents of the mind map on the theme: "escaping insulin injection errors"

一级子主题	二级子主题	三级子主题	四级子主题
正确认识胰岛素	根据病情尽早使用；不会上瘾	/	/
胰岛素注射部位	腹部；臀部；大腿前侧及外侧；上臂三角肌下缘	/	/
胰岛素储存	已开启	开启后有效期为1个月；室温≤25 ℃阴凉处	/
	未开启	使用前室温放置1~2 h；不可冷冻	/
注射部位轮换原则	同一部位轮换原则	注射点间至少间隔1 cm；避免1个月内使用同一注射点	/
	注射部位左右轮换原则	左1周，右1周，对称轮换；左1次，右1次，对称轮换	/
	不同部位轮换原则(吸收速度从快到慢)	腹部(避开脐5 cm)；上臂；大腿；臀部	/
胰岛素注射方法	注射前	洗手；核对；安装笔芯；摇匀预混胰岛素；装针头排气，旋转到所需剂量	/
	注射时	消毒，判断是否捏皮和进针角度	使用较短针头(4 cm或5 cm)时，无需捏皮，90°进针
	注射后	注射完毕后将针头留置10 s拔针	使用较长≥8 cm的针头或极瘦者，捏皮，90°或45°进针
重复使用针头的危害	疼痛；感染；针头折断；针头阻塞；注射剂量改变；皮下脂肪增生或硬结	/	/
减轻注射疼痛的方法	注射针头	使用一次性、细小针头	/
	注射部位	消毒液待干后注射；室温下注射；避免体毛根部注射	/
低血糖的预防和处理	表现	心慌、头晕、冷汗等	/
	预防	熟知糖尿病知识；定时定量进餐；戒烟限酒	/
	处理	外出携带糖果、饼干等；轻度低血糖可口服15~20 g碳水化合物；重度低血糖及时就医	/
注：/表示无。

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表 3 2组T2DM患者干预前后胰岛素注射知识掌握水平比较(例)

Table 3. Comparison of insulin injection knowledge before and after intervention between two groups of T2DM patients (cases)

组别	例数	时间点	条目1	条目2	条目3	条目4	条目5	条目6	条目7	条目8	条目9
对照组	51	干预前	30	23	24	25	19	22	18	22	24
		干预后	41	33	35	40	30	32	37	36	35
χ²值			5.608	3.960	4.865	9.543	4.752	3.935	14.245	7.834	4.865
P值			0.018	0.047	0.027	0.002	0.029	0.047	＜0.001	0.005	0.027
试验组	50	干预前	32	24	21	26	23	20	18	21	22
		干预后	49^a	43^a	47^a	48^a	44^a	43^a	46^a	47^a	43^a
χ²值			18.778	16.328	31.066	25.156	19.946	22.694	34.028	31.066	19.385
P值			＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
Waldχ_组间²			33.421	24.367	35.909	37.891	45.678	20.091	19.347	24.578	17.341
P值_组间			＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
Waldχ_时间²			89.231	77.324	60.091	85.231	90.092	77.341	56.901	88.341	82.311
P值_时间			＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
Waldχ_交互²			54.451	45.231	52.123	63.241	77.783	59.093	34.091	65.231	55.781
P值_交互			＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	时间点	条目10	条目11	条目12		条目13	条目14	条目15	条目16	条目17
对照组	51	干预前	19	22	28		20	19	24	25	21
		干预后	35	36	41		32	31	37	38	34
χ²值			10.074	7.834	6.940		5.649	5.649	6.892	7.016	6.669
P值			0.002	0.005	0.008		0.017	0.017	0.009	0.008	0.010
试验组	50	干预前	23	20	25		25	18	33	25	23
		干预后	45^a	44^a	47^a		44^a	41^a	45^a	46^a	42^a
χ²值			22.243	25.000	24.008		16.877	21.869	8.392	21.418	15.868
P值			＜0.001	＜0.001	＜0.001		＜0.001	＜0.001	0.004	＜0.001	＜0.001
Waldχ_组间²			44.379	20.098	23.112		20.093	15.781	16.453	26.741	31.446
P值_组间			＜0.001	＜0.001	＜0.001		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
Waldχ_时间²			100.091	67.231	76.341		88.237	60.093	84.341	86.732	94.323
P值_时间			＜0.001	＜0.001	＜0.001		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
Waldχ_交互²			88.321	42.345	50.097		55.093	43.891	40.901	58.341	77.893
P值_交互			＜0.001	＜0.001	＜0.001		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05。

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表 4 2组T2DM患者干预前后胰岛素注射技术掌握情况比较(x±s，分)

Table 4. Comparison of insulin injection techniques before and after intervention between two groups of T2DM patients (x±s, points)

组别	例数	①		②		③		④		⑤
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	51	0.56±0.11	1.89±0.45^b	1.11±0.14	1.90±0.45^b	0.78±0.18	1.58±0.34^b	0.88±0.21	2.01±0.42^b	0.97±0.22	1.76±0.42^b
试验组	50	0.60±0.17	2.55±0.36^b	1.08±0.16	2.39±0.51^b	0.81±0.19	2.23±0.51^b	0.81±0.19	2.61±0.30^b	1.01±0.13	2.39±0.55^b
统计量		1.406^a	15.671^c	1.003^a	17.341^c	0.815^a	7.550^c	1.756^a	17.451^c	1.110^a	19.341^c
P值		0.163	＜0.001	0.318	＜0.001	0.417	＜0.001	0.082	＜0.001	0.270	＜0.001

组别	例数	⑥		⑦		⑧		⑨
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前			干预后
对照组	51	0.92±0.23	1.83±0.44^b	0.66±0.12	1.93±0.41^b	0.84±0.15	2.01±0.45^b	0.72±0.14		1.94±0.43^b
试验组	50	0.96±0.18	2.44±0.50^b	0.71±0.17	2.47±0.41^b	0.83±0.20	2.61±0.31^b	0.70±0.11		2.47±0.43^b
统计量		0.972^a	20.098^c	1.710^a	21.431^c	0.285^a	18.341^c	0.797^a		22.123^c
P值		0.333	＜0.001	0.090	＜0.001	0.777	＜0.001	0.427		＜0.001
注：^a为t值，^c为F值; 与同组干预前比较，^bP＜0.05。①~⑨为胰岛素注射的9个步骤。

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表 5 2组T2DM患者干预前后血糖水平比较(x±s)

Table 5. Comparison of blood glucose levels before and after intervention between two groups of T2DM patients (x±s)

组别	例数	糖化血红蛋白(%)		空腹血糖(mmol/L)		餐后2h血糖(mmol/L)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	51	8.90±1.12	7.05±1.26^b	10.01±2.44	8.11±2.37^b	13.45±3.11	10.58±2.57^b
试验组	50	8.67±1.56	5.68±1.14^b	10.17±3.09	6.77±1.25^b	13.61±3.44	9.01±2.31^b
统计量		0.852^a	19.726^c	0.289^a	18.544^c	0.245^a	17.227^c
P值		0.396	＜0.001	0.773	＜0.001	0.807	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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参考文献(16)

[1]	刘素荣, 张金艳, 杨旭, 等. 津力达颗粒联合德谷胰岛素利拉鲁肽注射液治疗血糖控制不佳2型糖尿病的临床疗效[J]. 中国现代医学杂志, 2024, 34(15): 65-70. LIU S R, ZHANG J Y, YANG X, et al. Clinical efficacy of Jinlida granule combined with Degu insulin Liraglutide injection in the treatment of T2DM with poor glycemic control[J]. China Journal of Modern Medicine, 2024, 34(15): 65-70.
[2]	KIM J Y, JIN S M, SIM K H, et al. Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial[J]. Diabetologia, 2024, 67(7): 1223-1234. doi: 10.1007/s00125-024-06152-1
[3]	郑丽妹, 韩玉琴, 于雪梅, 等. 基于达标理论的微信平台教育在2型糖尿病患者胰岛素注射中的应用效果[J]. 护理实践与研究, 2023, 20(20): 3096-3101. ZHENG L M, HAN Y Q, YU X M, et al. Application effect of WeChat platform education based on goal attainment theory in insulin injection for type 2 diabetes mellitus patients[J]. Nursing Practice and Research, 2023, 20(20): 3096-3101.
[4]	邓彩金, 陈秀英, 陈秀媚, 等. 老年糖尿病患者胰岛素注射知信行现状及培训需求调查[J]. 保健医学研究与实践, 2023, 20(9): 119-122. DENG C J, CHEN X Y, CHEN X M, et al. Knowledge-attitud-practice and training needs of elderly diabetic patients with insulin injection[J]. Health Medicine Research and Practice, 2023, 20(9): 119-122.
[5]	刘静, 刘杨, 李玉梅, 等. PBL联合CBL在本科生肺癌临床见习带教中的应用研究[J]. 中华全科医学, 2023, 21(8): 1407-1410. doi: 10.16766/j.cnki.issn.1674-4152.003133 LIU J, LIU Y, LI Y M, et al. Research on the application of PBL combined with CBL in the clinical practice teaching for lung cancer[J]. Chinese Journal of General Practice, 2023, 21(8): 1407-1410. doi: 10.16766/j.cnki.issn.1674-4152.003133
[6]	朱英标, 官常荣, 吕锦, 等. 思维导图法在癫痫教学中的应用[J]. 中华全科医学, 2023, 21(3): 502-504. ZHU Y B, GUAN C R, LYU J, et al. Application of mind mapping in epilepsy teaching[J]. Chinese Journal of General Practice, 2023, 21(3): 502-504.
[7]	解焕鑫, 杨华清, 李强, 等. 依托网络的案例教学法联合思维导图教学模式在骨科康复教学中的应用与评价[J]. 中国医刊, 2023, 58(3): 345-348. XIE H X, YANG H Q, LI Q, et al. Application and evaluation of Web-based case teaching method combined with mind mapping teaching mode in orthopedic rehabilitation teaching[J]. Chinese Journal of Medicine, 2023, 58(3): 345-348.
[8]	钟健, 洪秀丽. 厦门市糖尿病患者胰岛素皮下注射知识知晓现状调查[J]. 中国卫生标准管理, 2023, 14(23): 195-198. ZHONG J, HONG X L. Investigation on the current situation of knowledge of subcutaneous injection of insulin in diabetic patients in Xiamen[J]. China Health Standard Management, 2023, 14(23): 195-198.
[9]	姚文君, 顾康琛, 王龙胜, 等. 探讨思维导图联合CBL教学法在心血管影像教学中的应用[J]. 心脏杂志, 2021, 33(4): 456-459. YAO W J, GU K C, WANG L S, et al. Application of mind mapping combined with case-based learning in cardiovascular imaging teaching[J]. Chinese Heart Journal, 2021, 33(4): 456-459.
[10]	刘凤春, 宋晓萌, 李翠景, 等. 进展性案例结合思维导图教学法在神经内科低年资护士培训中的应用效果[J]. 护理研究, 2021, 35(22): 4093-4096. LIU F C, SONG X M, LI C J, et al. Application effect of teaching method based on progressive case combined with mind map in the training of junior nurses in neurology department[J]. Chinese Nursing Research, 2021, 35(22): 4093-4096.
[11]	冯纯敏, 林曼娜, 胡郁刚, 等. 运用思维导图在国家标准化代谢性疾病管理中心(MMC)糖尿病患者健康教育中的应用效果研究[J]. 糖尿病新世界, 2023, 26(11): 4-7. FENG C M, LIN M N, HU Y G, et al. Study on the effectiveness of using mind map in the application of health education for diabetic patients in National Metabolic Management Center(MMC)[J]. Diabetes New World Magazine, 2023, 26(11): 4-7.
[12]	王丽. 拼图式思维导图在教育初次使用胰岛素注射装置病人中的观察研究[J]. 蚌埠医学院学报, 2021, 46(8): 1138-1140, 1145. WANG L. Study on the value of the puzzle mind mapping in the education of patients using insulin injection devices for the first time[J]. Journal of Bengbu Medical College, 2021, 46(8): 1138-1140, 1145.
[13]	李瑜. 2型糖尿病胰岛素注射护理中应用临床护理路径效果分析[J]. 生命科学仪器, 2022, 20(z1): 435. LI Y. Effect analysis of clinical nursing pathway in insulin injection nursing of type 2 diabetes mellitus[J]. Life Science Instruments, 2022, 20(z1): 435.
[14]	NETERE A K, ASHETE E, GEBREYOHANNES E A, et al. Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals[J]. BMC Public Health, 2020, 20(1): 1537. DOI: 10.1186/s12889-020-09622-4.
[15]	赵钦, 侯晓娟, 刘月芹, 等. 回授法在糖尿病患者胰岛素注射院后管理中的效果[J]. 国际护理学杂志, 2021, 40(18): 3317-3319. ZHAO Q, HOU X J, LIU Y Q, et al. Effect of response therapy on post-hospital management of insulin injection in diabetic patients[J]. International Journal of Nursing, 2021, 40(18): 3317-3319.
[16]	于健, 王洪, 周美景, 等. 老年2型糖尿病患者胰岛素注射行为现状及其对皮下脂肪增生的影响[J]. 中华糖尿病杂志, 2023, 15(8): 714-719. YU J, WANG H, ZHOU M J, et al. Status of insulin injection behavior in elderly patients with type 2 diabetes and its effects on insulin injection induced lipohypertrophy[J]. Chinese Journal of Diabetes Mellitus, 2023, 15(8): 714-719.