围产期实施临床路径指导的护理策略对妊娠合并糖尿病产妇的分娩结局影响

Effct of perinatal nursing strategy guided by clinical pathway on the delivery outcome of pregnant women complicated with diabetes mellitus

目的考察围产期内实施临床路径指导的护理策略对妊娠合并糖尿病产妇的分娩结局影响。方法选取2019年1月-2020年5月于华中科技大学同济医学院附属同济医院产检并分娩的产妇120例作为研究对象,根据护理策略的不同分为对照组和观察组,每组60例。对照组患者采用常规护理策略,观察组患者实施临床路径为指导的护理策略,比较两组护理前后血糖水平和胰岛素抵抗情况,并考察新生儿并发症发生率和分娩结局。结果护理前,两组间空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2hPG)、稳态模型评估-胰岛B细胞功能(HOMA-B)和稳态模型评估-胰岛素抵抗(HOMA-IR)比较,差异均无统计学意义(P值均>0.05)。护理后,观察组的HbA1c、FPG和2hPG水平均显著低于对照组(P值均<0.05);观察组的HOMA-B显著高于对照组(P<0.05),HOMA-IR显著低于对照组(P<0.05)。观察组新生儿低血糖和巨大儿的发生率均显著低于对照组(P值均<0.05);观察组羊水过多、产后出血和早产发生率均显著低于对照组(P值均<0.05)。结论围产期内实施临床路径为指导的护理策略能够有效控制妊娠合并糖尿病产妇的血糖水平,改善分娩结局。

Objective To investigate the effect of perinatal nursing strategy guided by clinical pathway on the delivery outcome of pregnant women complicated with diabetes mellitus.Methods 120 cases of parturients who underwent obstetric examination and delivered in Tongji Hospital,Tongji Medical College,Huazhong University of science and technology from January 2019 to May 2020 were collected as the research subjects and divided into a control group and an observation group according to different nursing strategies,with 60 cases in each group.Patients in the control group were treated with conventional nursing strategy,while patients in the observation group were treated with nursing strategy guided by clinical pathway.The blood glucose level and insulin resistance between the two groups before and after nursing and the incidence of neonatal complications and outcome of delivery were compared.Results Before nursing,there were no statistically significant differences between fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),2-h postprandial blood glucose(2hPG),homeostasis model asscssment of B-cell function(HOMA-B)and homecostasis model assessment of insulin resistance(HOMA-IR)levels(all P>0.05).After nursing,compared with the control group,the levels of HbA1c,FPG and 2hPG in the observation group were significantly decreased(all P<0.05).After nursing,compared with the control group,the HOMA-B in the observation group was significantly increased,and the HOMA-IR was significantly decreased(P<0.05).The incidence of neonatal hypoglycemia and macrosomia in the observation group was significantly lower than that in the control group(both P<0.05).The incidence of polyhydramnios,postpartum hemorrhage and premature delivery in the observation group was significantly lower than that of the control group(all P<0.05).Conclusion Perinatal nursing strategy guided by clinical pathway can effectively control the blood glucose level of pregnant women with diabetes and improve the outcome of childbirth.