以家庭为单位的健康管理模式对社区妊娠糖尿病患者的效果评价

Effectiveness of household-based health management on community patients with gestational diabetes

目的 评价在社区实施以家庭为单位的健康管理对妊娠糖尿病（GDM）患者及其子代的影响.方法 2009年1月至2012年12月,选择枣庄市立医院新城社区84例单胎GDM患者,随机分为管理组和对照组.对两组孕妇均建立孕期健康管理档案,组建社区GDM健康管理团队,实施系统的健康教育、干预和随访至妊娠结束.管理组接受以家庭为单位的健康管理.对照组接受常规健康教育、干预、随访.比较两组孕妇入组时（孕24～28周）与分娩前末次血糖、血脂、血压、体质指数的变化及妊娠结局,分析以家庭为单位的健康管理的效果.结果 管理组和对照组GDM孕妇各42例.两组基线数据差异无统计学意义,具有可比性.两组孕妇分娩前末次空腹血糖、餐后2h血糖、收缩压、舒张压、BMI、孕期体重增加、总胆固醇、三酰甘油、低密度脂蛋白胆固醇比较,管理组均明显低于对照组,高密度脂蛋白胆固醇比较,管理组高于对照组,差异有统计学意义（t值分别为5.81、2.28、3.14、2.41、5.17、4.97、7.81、2.39、3.39、2.02,P＜0.05）；两组羊水过多、胎膜早破、妊娠期高血压疾病、顺产、剖宫产、巨大儿、新生儿低血糖差异有统计学意义（x2分别为4.61、4.48、4.48、4.94、4.27、4.48、4.76,P＜0.05）；管理后管理组健康行为（均衡膳食、规律运动、正确用药、规范监测、按时复诊、高低血糖处理、情绪管理）明显优于对照组,差异有统计学意义（x2分别为5.61、4.76、5.27、5.73、4.48、5.19、4.20,P＜0.05）.结论 对社区妊娠糖尿病患者实施以家庭为单位的健康管理,可以提高妊娠糖尿病患者的健康行为,改善代谢状况,改善妊娠糖尿病患者母婴结局.

Objective To evaluate the effect of household-based health management model on community patients with gestational diabetes.Methods Eighty-four singleton pregnant women with diabetes who visited New City Community Healthcare Center of Zaozhuang Municipal Hospital from January 2009 to December 2012 were randomly assigned to the management group （n =42） and the control group （n =42）.The pregnant women in the management group accepted household-based health management,and the pregnant women in the control group accepted conventional health education,intervention,and followup.Blood glucose,lipid profiles,blood pressure,body mass index （BMI） and pregnancy outcomes were compared between the two groups.Results There were no significant different of clinical characteristics between the two groups at baseline.Right before delivery,fasting plasma glucose,2 h postprandial blood glucose,blood pressure,childbirth BMI,pregnancy weight gain,total cholesterol,triglyceride and low-density lipoprotein cholesterol of the management group were significantly lower than those of the control group （t values were 5.81,2.28,3.14,2.41,5.17,4.97,7.81,2.39 and 3.39,respectively; all P ＜0.05）,however high-density lipoprotein cholesterol was relatively higher （t =2.02,P ＜ 0.05）.Polyhydramnios,premature rupture of membranes,hypertensive disorders in pregnancy,natural labour,cesarean section,fetal macrosomia and neonatal hypoglycemia were found significantly different between the two groups （x2 values were 4.61,4.48,4.48,4.94,4.27,4.48 and 4.76,respectively; all P ＜ 0.05）.Health behavior of the management group was significantly improved following the intervention （for balanced diet,regular exercise,proper medication,standardized monitoring,timely referral,high and low blood sugar treatment and emotional management,x2 values were 5.61,4.76,5.27,5.73,4.48,5.19 and 4.20,respectively; all P ＜ 0.05）.Conclusion Household-based health management could improve health behavior,metabolic status and maternal or neonatal outcomes of community patients with gestational diabetes.