专科护士主导的MDT延续护理在妊娠期糖尿病伴亚临床甲减病人护理中的应用

Application of MDT continuing nursing led by specialist nurses in the nursing of patients with gestational diabetes mellitus accompanied by subclinical hypothyroidism

目的:探讨专科护士主导的多学科团队(MDT)延续护理在妊娠期糖尿病(GDM)伴亚临床甲状腺功能减退症病人护理中的应用效果。方法:2018年1月—2019年12月,便利选取某三级甲等医院门诊收治的160例GDM伴亚临床甲状腺功能减退症病人为研究对象,分为两组各80例。对照组接受常规随访管理,观察组在常规随访管理的基础上实施专科护士主导的MDT延续护理,比较两组病人分娩前血糖水平、血清促甲状腺激素(TSH)及激惹、抑郁和焦虑量表(IDA)评分及妊娠结局。结果:观察组分娩前空腹血糖、餐后2 h血糖、糖化血红蛋白、TSH、IDA总分分别为(6.32±1.11)mmol/L、(9.45±0.44)mmol/L、(7.11±1.91)%、(2.61±0.34)mU/L、(22.54±2.35)分,对照组分娩前空腹血糖、餐后2 h血糖、糖化血红蛋白、TSH、IDA总分分别为(7.86±1.62)mmol/L、(11.22±0.90)mmol/L、(9.45±1.69)%、(4.85±0.57)mU/L、(28.34±4.89)分,两组比较差异均有统计学意义(P<0.001);观察组流产或早产、胎儿宫内窘迫、低体重儿及新生儿低血糖发生率均低于对照组(P<0.05)。结论:专科护士主导的MDT延续护理有利于降低GDM伴亚临床甲状腺功能减退症病人血糖及不良妊娠结局,可以改善甲状腺功能及焦虑、抑郁等负性情绪。

Objective:To explore the application effect of the multidisciplinary team(MDT)continuing care led by specialist nurses in nursing of patients with Gestational Diabetes Mellitus(GDM)accompanied by subclinical hypothyroidism.Methods:From January 2018 to December 2019,a total of 160 cases of pregnant women with GDM and subclinical hypothyroidism admitted to the outpatient clinic of a tertiary grade⁃A hospital,were conveniently selected as the research objects.And they were divided into two groups,each with 80 cases.The control group received routine follow⁃up management.And the observation group received MDT continuing care led by specialist nurses based on the routine follow⁃up management.The pre⁃delivery blood glucose level,serum thyroid⁃stimulating hormone(TSH),the score of Irritability,Depression and Anxiety Scale(IDA),and pregnancy outcome were compared between the two groups.Results:In the observation group,the total scores of pre⁃delivery fasting blood glucose,2 h postprandial blood glucose,glycosylated hemoglobin,TSH,and IDA of patients were(6.32±1.11)mmol/L,(9.45±0.44)mmol/L,(7.11±1.91)%,(2.61±0.34)mU/L,and(22.54±2.35)points.While,in the control group,they were(7.86±1.62)mmol/L,(11.22±0.90)mmol/L,(9.45±1.69)%,(4.85±0.57)mU/L,(28.34±4.89)points.The differences between the two groups were statistically significant(P<0.001).The incidence rates of miscarriage or premature delivery,fetal distress,low⁃weight infants,and neonatal hypoglycemia in the observation group were lower than those in the control group(P<0.05).Conclusions:MDT continuing nursing led by specialist nurses could reduce blood glucose and adverse pregnancy outcomes in GDM and subclinical hypothyroidism patients.It also could improve thyroid function and relilieve negative emotions,such as anxiety and depression.