“五师共管”模式在妊娠期糖尿病患者中的应用与效果研究

Study on the application and effects of "Five Divisions Co-management" model on gestational diabetes mellitus patients

目的探讨以知-信-行模式构建的"五师共管"家庭社区医生团队服务模式的应用及效果,为社区妊娠期糖尿病(GDM)患者管理提供依据。方法选取2015年1月起至2016年8月苏州市立医院4家直属社区卫生服务中心管理的122例GDM患者作为研究对象,根据自愿原则分为"五师共管"组72例和对照组50例。"五师共管"组采用"五师共管"模式进行干预,对照组采用常规健康教育和随访监测干预,时间均从妊娠建卡明确GDM诊断至产后6个月。比较两组不同时间点GDM防治知识知晓情况,自我管理技术正确情况,空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(HbA1C)水平、母儿并发症及不良妊娠结局等指标。采用SPSS 18.0软件进行t检验、χ2检验。结果预产期1个月内"五师共管"组GDM防治知识总知晓率(91.7%)、自我管理技术总正确率(91.1%)均高于对照组(分别为78.3%、78.6%),差异均有统计学意义(P<0.01)。预产期1个月内、产后3及6个月"五师共管"组坚持饮食调控、坚持运动、定期监测血糖的比例高于对照组,差异均有统计学意义(P<0.05,P<0.01)。预产期1个月内,"五师共管"组FPG、2 h PG和HbA1C水平均低于对照组,差异均有统计学意义(P<0.05)。产后6个月,"五师共管"组口服葡萄糖耐量试验(OGTT)后2 h PG达标率(97.2%)较对照组(86.0%)高,差异有统计学意义(P<0.01)。"五师共管"组新生儿并发症总发生率(16.7%)低于对照组(36.0%),孕产妇并发症及不良妊娠结局总发生率(20.8%)也低于对照组(44.0%),差异均有统计学意义(P<0.05)。结论"五师共管"模式能够明显改善GDM患者在孕期及产后健康相关行为,降低糖代谢异常的发生,减少母儿并发症及不良妊娠结局的发生,有一定的推广价值。

Objective To explore the application and effects of"Five Divisions Co-management"family community doctor team service model on the basis of knowledge-attitude-belief model,and to provide the basis for the management of community patients with gestational diabetes mellitus(GDM).Methods From January 2015 to August 2016,122 patients with GDM in four community health service centers under Suzhou municipal hospital were selected as the subjects.The subjects were divided into two groups by the voluntary principle."Five Divisions Co-management"group(72 cases)was intervened by"Five Divisions Comanagement"model.The control group(50 cases)was treated by routine health education and follow-up monitoring interventions.The duration was from the diagnosis of GDM after pregnancy to the six months after birth.The t test andχ2 test were used to compare the differences of GDM awareness,management by self,FPG,2 h PG,HbA1 C,complications of mother and child and adverse pregnancy outcomes between two groups and different time points.The used software was SPSS 18.0.Results Within one month of the expected date of delivery,the correct awareness rates of GDM prevention and treatment knowledge and self-management techniques(91.7%and 91.1%)in the"Five Divisions Co-management"group were significantly higher than those(78.3%and 78.6%)in the control group(P<0.01).Within one month of the expected date of delivery,3 and 6 months after delivery,the proportions of diet regulation and control,exercises and regulative detection of blood glucose in the"Five Divisions Co-management"group were significantly higher than those in the control group(P<0.05 or P<0.01).Within one month of the expected date of delivery,the FPG,2 h PG and HbA1 Clevels in the"Five Divisions Co-management"group were significantly lower than those in the control group(P<0.05).In 6 months after delivery,the compliance rate(97.2%)of 2 h PG after OGTT in the"Five Divisions Co-management"group was significantly higher than that(86.0%)in the control group(P<0.01).Total incidence(16.7%)of neonatal complications in the"Five Divisions Co-management"group was significantly lower than that(36.0%)in the control group;total incidence(20.8%)of complications and adverse pregnancy outcomes in pregnant women in the"Five Divisions Co-management"group was significantly lower than that(44.0%)in the control group,(P<0.05).Conclusion The"Five Divisions Co-management"health management model can significantly improve the health-related behaviors of GDM patients during pregnancy and postpartum,and reduce the occurrence of abnormal blood glucose metabolism,mother-child complication and adverse pregnancy outcomes,"Five Divisions Co-management"health management model is worth promoting in the communities.