綜合護理干預在妊娠期糖尿病孕婦中的應用

陳金秀 魏小梨 單月玲

[摘要]目的 探討綜合護理干預在妊娠期糖尿病（GDM）孕婦中的應用效果。方法 選取2017年1月～2018年12月我院收治的800例GDM孕婦作為研究對象，按照隨機法分為對照組（n=400）和觀察組（n=400）。對照組采用常規護理方法，觀察組采用綜合護理干預方法。比較兩組的血糖漏測率、母嬰分離率、剖宮產率及新生兒并發癥。結果 觀察組血糖漏測率、母嬰分離率及剖宮產率低于對照組，差異均有統計學意義（P<0.05）;觀察組的早產兒、新生兒窒息及巨大兒發生率低于對照組，差異均有統計學意義（P<0.05）;觀察組護理總滿意度為92.8%，高于對照組的83.5%，差異有統計學意義（P<0.05）。結論 綜合護理干預可明顯降低GDM孕婦血糖漏測率，提高血糖監測依從性，同時也降低了剖宮產率和母嬰分離率，減少新生兒并發癥，改善了妊娠結局，既減輕了經濟負擔，也提高了GDM孕婦滿意度。

[關鍵詞]綜合干預;妊娠期糖尿病;應用;妊娠結局

[Abstract] Objective To explore the application effect of comprehensive nursing intervention in pregnant women with gestational diabetes mellitus （GDM）. Methods Altogether 800 cases pregnant women with GDM admitted to the our hospital from January 2017 to December 2018 were selected as research objects. They were randomly divided into control group （n=400） and observation group （n=400）. The control group adopted conventional nursing method， and the observation group adopted comprehensive nursing intervention method. Blood glucose leakage rate， maternal and infant separation rate， cesarean section rate and neonatal complications were compared between the two groups. Results The blood glucose leakage rate， maternal and child separation rate and cesarean section rate in the observation group were lower than those in the control group， with statistical differences （P<0.05）. The incidence of premature， neonatal asphyxia and macrosomia in the observation group were lower than those in the control group， with statistical differences （P<0.05）. The total satisfaction of the observation group was 92.8%， higher than that of the control group （83.5%）， and the difference was statistically significant （P<0.05）. Conclusion Comprehensive intervention can significantly reduce the rate of blood glucose leakage in GDM pregnant women， improve the compliance of blood glucose monitoring， reduce the rate of cesarean section and maternal and infant separation， reduce neonatal complications， improve the pregnancy outcome， and it does not only reduce the economic burden， but also improve the satisfaction of GDM pregnant women.

[Key words] Comprehensive intervention; Gestational diabetes; Application; Pregnancy outcomes

妊娠期糖尿病（GDM）指妊娠前糖代謝正常，妊娠后才出現的糖尿病[1]。孕期胎盤分泌人胎盤催乳素、胎盤胰島素酶，尤其腫瘤壞死因子等物質均可拮抗胰島素的降糖作用，隨著妊娠周數增加，拮抗胰島素作用增強，若胰島β細胞無法代償這一作用，則不能維持正常血糖水平[2]。隨著人們生活水平的提高，近年來GDM有逐年增長的趨勢，嚴重影響母胎安全，其基本的病理生理變化為胰島素相對或絕對不足所導致的糖、蛋白質、脂肪、水及電解質等代謝失調，以血糖升高為特點。在血糖控制不理想的GDM患者中，孕婦高血糖會導致胎兒血糖濃度升高，后者刺激胎兒胰島分泌胰島素增加，使胎兒合成代謝旺盛，胎兒生長發育過快，巨大兒發生率增加。胎兒代謝增加的同時機體對氧氣需要量也增加，可引起胎兒慢性缺氧狀態[3]。血糖監測是GDM管理的重要內容。但由于各種因素影響，孕婦監測血糖依從性不高。我院是本地區的重癥孕產婦救治中心，收治GDM患者較多，提高孕婦血糖監測依從性，降低血糖漏測率，改善圍生結局，是產科工作的重要課題。本研究通過多種措施干預，提高孕婦血糖監測依從性改善妊娠結局方面取得一定效果，現報道如下。