以一日门诊为基础的综合管理模式对妊娠期糖尿病患者的效果研究

Effect of Comprehensive Management Mode Based on One-day Care in Outpatient on Women with Gestational Diabetes Mellitus

目的探讨以一日门诊为基础的综合管理模式对妊娠期糖尿病(GDM)患者体质量、血糖、母婴并发症的影响。方法选取2013年12月—2015年12月于浙江大学医学院附属妇产科医院确诊为GDM患者1 870例为研究对象,根据自愿原则,920例纳入对照组,950例纳入研究组。对照组采用常规管理干预模式;研究组采用以一日门诊为基础的综合管理模式,主要内容包括GDM相关知识宣教,医学营养治疗相关知识介绍,饮食、运动、血糖监测指导。采用自制测试问卷评价两组GDM患者GDM相关知识认知情况,记录妊娠前及产前体质量、体质指数(BMI),记录干预前后空腹血糖、餐前血糖、餐后2 h血糖水平,以及围生期并发症、围生儿并发症的发生率。结果研究组GDM患者基础知识、母婴危害、饮食知识、运动知识、血糖监测、体质量管理及格率均高于对照组(P<0.05)。研究组GDM患者妊娠期体质量、BMI增长量均低于对照组(P<0.05)。干预后,研究组GDM患者空腹血糖、餐前血糖、餐后2 h血糖水平均低于对照组(P<0.05);两组干预后空腹血糖、餐前血糖、餐后2 h血糖水平均低于干预前(P<0.05)。研究组妊娠期高血压疾病、羊水过多、产后出血、巨大儿、新生儿窒息、新生儿低血糖发生率均低于对照组(P<0.05)。结论以一日门诊为基础的综合管理模式可提高GDM患者对疾病的认知,控制体质量增长,维持血糖稳定,降低母婴不良妊娠结局的发生风险。

Objective To explore the effect of comprehensive management mode based on one - clay care in outpatient on the body mass, blood glucose and maternal - neonatal complications of women with gestational diabetes mellitus （ GDM ）. Methods A total of 1 870 pregnant women diagnosed with GDM in Department of Obstetrics and Gynaecology, Women＇s Hospital, School of Medicine, Zhejiang University from December 2013 to December 2015 were included as the research objects. According to the voluntary principle, 920 cases were included in the control group, and 950 in the research group. The control group was intervened by conventional management mode. The research group was intervened by the comprehensive management mode that based on one - clay care in outpatient, of which the main contents included propaganda and education of relevant knowledge about GDM, knowledge about medical nutrition treatment, diet, exercise and blood glucose monitoring guidance. The cognition of relevant knowledge about GDM of women with GDM was evaluated by self - designed questionnaires. Pre - pregnancy and prenatal body mass and body mass index （BMI） , and the levels of fasting blood glucose, preprandial blood glucose, two - hour postprandial blood glucose before and after intervention and the incidence of perinatal complications and perinatal fetus complications were recorded. Results The pass rates of basic knowledge, maternal -neonatal risk, diet knowledge, exercise knowledge, blood glucose monitoring, and body mass management in the research group were higher than those in the control group （ P 〈 0. 05 ）. In the research group, the growth amount of body weight and BMI of women with GDM during gestation period were lower than those in the control group （ P 〈 0. 05 ）. After intervention, the levels of fasting blood glucose, preprandial blood glucose, two- hour postprandial blood glucose in the research group were lower than those in the control group （ P 〈 0. 05 ） ; the levels of fasting blood glucose, preprandial blood glucose and two - hour postprandial blood glucose ＇after intervention in the two groups were lower than those before intervention （ P 〈 0. 05 ）. The incidence rates of hypertensive disorder complicating pregnancy, polyhydramnios, postpartum hemorrhage, macrosomia, neonatal asphyxia, and neonatal hypoglycemia in the research group were lower than those in the control group （ P 〈 0. 05 ）. Conclusion The comprehensive management model based on one - day care in outpatient can improve the cognition of the disease of women with GDM, control the growth of body weight, maintain the stalaility of blood glucose, and reduce the risk of adverse pregnancy outcomes of mothers and infants.