妊娠期糖尿病患者孕期自我管理现状及影响因素分析

Current status and influential factors of self-management in women with gestational diabetes mellitus

目的了解妊娠期糖尿病(GDM)患者的自我管理现状并探讨其影响因素。方法采用GDM自我管理行为问卷及影响因素问卷,于2017年10月至12月,对就诊于北京地区5家公立医院产科的158例GDM患者进行调查。结果 GDM患者自我管理各维度得分率由高到低依次为定期产检7分、膳食控制(46.38±10.64)分、药物治疗(8.16±3.49)分、体重管理(7.85±4.44)分、血糖监测(11.29±5.42)分、运动管理(16.66±7.34)分。多元回归显示文化程度、本次受孕方式、焦虑、自我效能、疾病知识可以解释饮食自我管理总变异的31.01%;受孕方式、社会支持可以解释运动自我管理总变异的5.54%。孕期工作状态、妊娠次数、分娩次数、住院控糖经历、抑郁情绪、社会支持、疾病知识解释血糖监测自我管理总变异的15.64%。年龄、孕期工作状态、家庭人均月收入、医疗费用支付方式、焦虑、疾病知识可以解释体重自我管理总变异的11.71%;职业、家庭人均月收入、住院控糖经历、疾病知识可以解释遵医嘱服药自我管理总变异的50.33%。结论 GDM患者的自我管理行为不是很理想。定期复查自我管理最好,运动自我管理最差。疾病知识、家庭收入、住院控糖经历、孕期工作状态及社会支持是影响GDM患者自我管理行为的主要因素。

Objective To investigate the current status of self-management of patients with gestational diabetes mellitus （GDM） and analyze its influential factors. Methods A total of 158 cases of GDM from five general hospitals in Beijing were recruited from October to December in 2017 and were investigated with GDM Self-management Activities Questionnaire and influential factors questionnaires. Results The score rate of self-management dimensionalities from high to low were 7 points for regular check-up, 46.38 ± 10.64 for dietary control, 8.16 ±3.49 for medical treatment, 7.85 ±4.44 for weight management, 11.29 ±5.42 for blood glucose monitoring and 16.66± 7.34 for exercise management. Multiple linear regression indicated that educational level, the way of conception, anxiety, self-efficacy, and diseases knowledge explained 31.01% of the variation in dietary self-management. For exercise self-management, the way of conception and social support explained 5. 54% of the variance. For blood glucose monitoring, work status in pregnancy, number of pregnancies, number of births, hospitalization for blood sugar control, depression, social support, and diseases knowledge explained 15.64% of the variance. For weight self-management, age, work status in pregnancy, family monthly income, medical expenses payment method, anxiety and diseases knowledge could explain 11.71% of the variance. For medical compliance, occupation, family monthly income per capita, hospitalization for blood sugar control, and diseases knowledge explained 50. 33% of the variance. Conclusion The current status of self-management in GDM patients is not ideal, among which regular check-up is best and exercise is worst. Diseases knowledge, family income, hospitalization for blood sugar control, work status in pregnancy and social support are the main factors affecting the self management behaviors of GDM patients.