多学科诊疗模式下“三位一体”无缝隙护理服务在妊娠期糖尿病患者中的应用

Effect of trinitarian seamless nursing service model in patients with gestational diabetes mellitus

目的探讨多学科诊疗模式下“三位一体”无缝隙护理服务在妊娠期糖尿病患者中的应用效果。方法 选择2012年9月～2014年9月深圳市第二人民医院孕检妊娠24～28周行口服葡萄糖耐量试验确诊为妊娠期糖尿病的200例患者为研究对象,采用随机数字表法将患者分为为观察组和对照组,每组各100例。对照组确诊后接受常规治疗和护理,观察组则接受多学科诊疗模式“三位一体”下无缝隙护理服务去控制血糖和体重。比较两组孕期胰岛素的使用率及体重指数（BMI）的变化情况;监测两组护理前后血糖相关指标;观察患者围生期孕妇及新生儿并发症的发生率。结果 观察组患者孕期需使用胰岛素控制血糖和△BMI≥6 kg/m^2者及孕期体重增加量均明显少于对照组,差异均有高度统计学意义（均P〈0.01）。观察组经护理后的空腹血糖、餐后2 h血糖及糖化血红蛋白均明显优于对照组,差异均有高度统计学意义（均P〈0.01）。观察组患者围生期的剖宫产、羊水过多、妊娠高血压综合征和产后出血者均明显少于对照组,差异均有统计学意义（P〈0.05或P〈0.01）。且观察组巨大儿、新生儿高胆红素血症、胎儿窘迫、死胎和胎儿畸胎者均显著少于对照组,差异均有统计学意义（P〈0.05或P〈0.01）。结论 多学科诊疗模式下“三位一体”无缝隙护理服务应用于妊娠期糖尿病患者中能将体重控制在合理增长范围内,可明显改善血糖相关指标,将血糖控制在合理水平,降低产妇围生期并发症和新生儿并发症的发生率,从而改善妊娠结局。

Objective To explore the effect of trinitarian seamless nursing service model in patients with gestational diabetes mellitus. Methods Two hundred pregnant women from September 2012 to September 2014 who were diagnosed as gestational diabetes mellitus by OGTT during the period of pregnancy test at the 24-28 weeks of gestation in the Second People＇s Hospital of Shenzhen City were selected as the study subjects. They were divided into the observation group and control group according to the random number table method, with 100 cases in each group. The control group received conventional nurse after they were diagnosed as gestational diabetes mellitus, while the observation group accepted trinitarian seamless nursing service model to control blood sugar and weight. The changes of insulin u- tilization and BMI of the two groups during pregnancy were compared; blood sugar indicators before and after nursing of two groups were supervised; the complications in the perinatal period and neonatal complications of patients in the two groups were observed. Results The utilization rate of insulin during pregnancy and the rate of Lk BMI ≥ 6 kg/m^2 and weight gain during pregnancy of observation group were all significantly lower than those of the control group, the differences were statistically significant （all P 〈 0.01）. FPG, 2hPG, HbA1c of the observation group after nursing were significantly less than those of the control group, the differences were statistically significant （all P 〈 0.05）. The patients of cesarean delivery hydramnios, pregnancy-induced hypertension syndrome in the perinatal period and postpartum hemorrhage in observation group were all significantly less than those in the control group, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. And the numbers of neonatal ma＇crosomia, high bilirubin hematic disease, fetal dis tress, stillbirth and defects in observation group were all significantly less than those in the control group, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. Conclusion Trinitarian seamless nursing service model of patients with gestational diabetes mellitus not only can control the weight in a scope of reasonable growth, but also can obviously improve blood sugar related index, control blood glucose at a reasonable level, and reduce maternal and neonatal complication rates significantly, thus improve the pregnancy denouement.