多模式联合护理对妊娠期糖尿病患者的干预效果

Intervention eff ect of multimodal combined nursing on patients with gestational diabetes

目的探讨多学科糖尿病护理团队(MDCT)+授权认知护理和时效性激励理论为基础的延伸性护理对妊娠期糖尿病(GDM)患者治疗依从性、血糖水平、生活质量以及妊娠结局等的影响。方法将2018年7月—2020年7月医院诊治的120例GDM患者按照组间基本资料均衡可比的原则分为对照组和观察组,观察组失访7例,最终对照组纳入60例,观察组纳入53例。对照组接受常规护理,观察组接受“MDCT+授权认知护理和时效性激励理论为基础的延伸性护理”。比较两组患者干预前及分娩前1周的糖尿病治疗依从性。比较两组患者干预前及分娩前1周空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)及干预后的血糖达标率。比较两组患者干预前及分娩前1周总体健康、活力、社会功能、精神健康维度的评分。对比两组不良妊娠结局的发生率及干预方法满意度。结果干预前,观察组与对照组糖尿病治疗依从性评分比较差异无统计学意义(P>0.05);干预后,观察组糖尿病治疗依从性评分高于对照组,差异有统计学意义(P<0.05)。干预前,观察组与对照组FBG、2hPBG、HbA1c比较差异均无统计学意义(P>0.05);干预后,观察组FBG、2hPBG、HbA1c均低于对照组,差异均有统计学意义(P<0.05)。干预前两组总体健康、活力、社会功能、精神健康4个维度的SF-36生活质量量表评分比较差异均无统计学意义(P>0.05);干预后,观察组4个维度的评分均高于对照组,差异均有统计学意义(P<0.05)。观察组胎儿羊水过多、胎膜早破和新生儿低血糖等妊娠不良结局的发生率均低于对照组,差异均有统计学意义(P<0.05)。观察组患者满意度评分高于对照组,差异有统计学意义(P<0.05)。结论“MDCT+授权认知护理和时效性激励理论为基础的延伸性护理”可提高GDM患者的治疗依从性,改善血糖水平及生活质量,降低母婴并发症发生率。

Objective To explore the influence of extended nursing based on multidisciplinary diabetes care team(MDCT)+authorized cognitive nursing and timeliness incentive theory on treatment compliance, blood glucose level,quality of life and pregnancy outcome of gestational diabetes mellitus(GDM) patients. Methods A total of 120 patients with GDM diagnosed and treated in the hospital from July 2018 to July 2020 were divided into the control group and the observation group according to the principle of balanced and comparable basic data between groups. Seven patients were lost in the observation group, 60 patients were included in the fi nal control group, and 53 patients were included in the observation group. The control group received routine nursing, while the observation group received "MDCT+authorized cognitive nursing and extended nursing based on the theory of timeliness incentive". The treatment compliance of diabetes before intervention and one week before delivery was compared between the two groups. the blood glucose compliance rate of fasting blood glucose(FBG), 2 hours postprandial blood glucose(2hPBG), glycated hemoglobin(HbA1c) was compared before intervention and one week before delivery in the two groups and after intervention. The scores of general health, vitality,social function and mental health were compared between the two groups before intervention and one week before delivery.The incidence of adverse pregnancy outcomes and satisfaction with intervention methods were compared between the two groups. Results Before the intervention, there was no signifi cant dif ference in the score of diabetes treatment compliance between the two groups(P>0.05). After the intervention, the score of diabetes treatment compliance in the observation group was higher than that in the control group, and the dif ference was statistically signifi cant(P<0.05). Before the intervention,there was no signifi cant dif ference in the FBG, 2hPBG and HbA1c between the two groups(P>0.05). After the intervention,the FBG, 2hPBG and HbA1c in the observation group were lower than those in the control group, and the dif ferences were statistically signifi cant(P<0.05). There was no signifi cant dif ference in the scores of SF-36 quality of life scale in the four dimensions of general health, vitality, social function and mental health between the two groups before intervention(P>0.05).After intervention, the scores of four dimensions in the observation group were higher than those in the control group, and the dif ferences were statistically signifi cant(P<0.05). The incidence of adverse pregnancy outcomes, such as fetal hydramnios,premature rupture of membranes and neonatal hypoglycemia, in the observation group was lower than that in the control group, and the dif ference was statistically signifi cant(P<0.05). The satisfaction score of patients in the observation group was higher than that in the control group, and the dif ference was statistically signifi cant(P<0.05). Conclusion The appliaction of "MDCT+authorized cognitive nursing and extended nursing based on timeliness incentive theory" can improve the treatment compliance of GDM patients, improve blood glucose level and quality of life, and reduce the incidence of maternal and infant complications.