妊娠期糖尿病产妇分娩的新生儿出生后24小时内血糖变化规律与护理对策

Analysis of blood glucose changes and nursing countermeasures in 24 hours after birth of the neonates delivered by mothers with gestation diabetes

目的探讨妊娠期糖尿病(gestation diabetes mellitus,GDM)产妇分娩的新生儿出生后24 h内母婴同室期间血糖变化规律及影响因素,并提出护理对策。方法回顾性收集2017年12月—2018年9月入住杭州市某三级甲等妇产科医院的884对GDM产妇的一般资料及分娩新生儿的一般资料和出生后3 h、6 h、12 h、24 h的血糖值,并对其影响因素进行相关性分析。结果新生儿出生后3 h、6 h发生低血糖各4例(0.45%),12 h、24 h无低血糖发生;3 h、6 h、12 h、24 h发生临界低血糖(不包含重复发生者)各30例(3.39%)、19例(2.17%)、7例(0.81%)和7例(0.81%)。产妇分娩方式(OR=3.834)、泌乳量(OR=7.006)及新生儿性别(OR=4.014)是新生儿出生后3 h发生临界低血糖的影响因素(P<0.05);产妇泌乳量是各时点发生临界低血糖的影响因素(P<0.05)。结论GDM产妇分娩的新生儿出生后24 h低血糖、临界低血糖的发生率随时间的延长逐渐降低。多种因素影响新生儿各时间点血糖的变化,择期剖宫产、母乳不足和男性新生儿是新生儿出生后3 h发生临界低血糖的独立影响因素。在临床护理工作中,对GDM产妇分娩的新生儿出生后24 h内母婴同室期间应进行分层、针对性的血糖观察和管理。

Objective To explore the trend and associated influencing factors of blood glucose in 24 hours after birth of the neonates delivered by gestation diabetes mellitus(GDM)mothers.Methods Mothers with a single birth and diagnosed with GDM during the pregnancy were enrolled from December 2017 to September 2018 in a tertiary women’s hospital in Hangzhou.Baseline data of the parturient women and neonates and blood glucose of the neonates at 3 h,6 h,12 h and 24 h after birth were collected.Results A total of 884 cases of GDM neonates were enrolled.Hypoglycemia occurred in 4 cases at 3 h and 6 h after birth respectively and no hypoglycemia occurred at 12 h and 24 h after birth.Besides,30 cases(3.39%),19 cases(2.17%),7 cases(0.81%),7 cases(0.81%)of critical hypoglycemia(excluding repetitive critical hypoglycemia)occurred at 3 h,6 h,12 h and 24 h after birth,respectively.The incidence of critical hypoglycemia at 3 h was statistically associated with the mode of delivery(OR=3.834),lactation volume(OR=7.006)and neonatal gender(OR=4.014)(P<0.05).Lactation deficiency was the major risk factor of critical hypoglycemia at each time point(P<0.05).Conclusion The incidence of hypoglycemia and critical hypoglycemia of rooming-in GDM neonates decreased gradually within 24 hours after birth.The blood glucose in GDM neonates at different time points was affected by multiple factors.Delivery mode,lactation volume,and gender were independent factors affecting critical hypoglycemia in GDM neonates at 3 h after birth.The implication for clinical practice was that hierarchical and targeted management should be conducted in caring rooming-in GDM neonates.