妊娠合并糖尿病系统管理效果的评价

Effectiveness of systematic management of diagnosis and treatment on pregnancy with gestational diabetes mellitus

目的探讨系统管理模式对妊娠合并糖尿病妊娠结局的影响。方法选择2006年10月至2008年5月就诊的妊娠期糖尿病患者116例作为对照组，据孕中期的对照组年龄、妊娠期糖尿病病情程度、身体质量指数以1：1匹配2008年7月至2012年10月妊娠期糖尿病患者116例为观察组，对两组资料进行回顾性分析，评价系统管理和传统诊治管理模式的临床效果。结果采用系统管理模式干预后，在遵医嘱行为、知识和技能及体重控制方面，观察组均优于对照组（X^2值分别为9．655、5．022、4．241、3．855，均P〈0．05）；观察组胰岛素治疗率显著低于对照组（X^2=5．422，P〈0．05），血糖控制满意率却显著高于对照组（X^2=9．655，P〈0．01）；孕妇剖宫产、妊娠期高血压疾病、羊水过多、胎膜早破、胎儿窘迫发生率及分娩新生儿中巨大儿、新生儿窒息、高胆红素血症、早产儿、新生儿低血糖发生率显著低于对照组（X^2值分别为13．414、14．500、5．773、5．847、6．124、8．867、8．156、13．152、13．441、5．141，均P〈0．05）；观察组失访率及产后42天、6个月糖代谢受损发生率也显著低于对照组（X^2值分别为4．241、5．067、9．710，均P〈0．05）。结论系统管理模式可有效地控制血糖，取得良好的妊娠结局，值得推广。

Objective To observe the influence of systematic management of diagnosis and treatment on pregnancy outcomes in patients with gestational diabetes mellitus （GDM）. Methods A hospital-based 1 ： 1 matched case-control study was conducted retrospectively. Each ease was matched with one control on age, disease condition and BMI. The observation group recruited 116 subjects selected from July 2008 to October 2012, and the control group included 116 subjects selected from October 2006 to May 2008. The clinical effect of systematic management and traditional diagnosis and treatment management was evaluated. Results With systematic nmnagement the observation group was superior to the control group in compliance behavior, knowledge, skill, and weight control （X^2 value was 9. 655, 5. 022, 4. 241 and 3. 855, respectively, all P 〈 0.05 ）. In the observation group the insulin treatment rate was significantly lower than the control group （X^2 = 5. 422, P 〈 0.05 ）, but the glucose control satisfaction degree was significantly higher （X^2 = 9. 655, P 〈 0.01 ）. Compared with the control group, the observation group had significant lower incidence of cesarean section, pregnancy imluced hypertension, hydramnios, premature rupture of membrane, fetal distress, fetal macrosomia, neonatal asphyxia, hyperbifirubincmia, premature labor, and neonatal hypoglycaemia （X^2 value was 13. 414, 14. 500, 5. 773, 5. 847, 6. 124, 8. 867, 8. 156, 13. 152, 13. 441 and 5. 141, respectively, all P 〈 0.05 ）. Conclusion The systematic management of diagnosis and treatment is significantly helpful for controlling blood glucose and reducing the risk of peripartum complications.