双C疗法联合循证护理对妊娠期糖尿病合并高血压患者心理应激、并发症及母婴结局的影响

Effects of double-C therapy combined with evidence-based nursing on psychological stress,complications and maternal and infant outcomes of GDM patients with gestational hypertension

目的分析双C疗法联合循证护理对妊娠期糖尿病(GDM)合并妊娠期高血压患者心理应激、并发症及母婴结局的影响。方法选取2020年1月至2022年5月复旦大学附属妇产科医院接收的176例GDM合并妊娠期高血压患者,根据不同护理方法分为观察组(循证护理,n=91)和对照组(常规护理,n=85),两组患者均采用双C疗法进行治疗。比较两组治疗前后血糖水平〔空腹血糖(FPG)、餐后2 h血糖(2hPG)及糖化血红蛋白(HbA1c)〕,对比两组情绪状态〔抑郁自评量表(SDS)、焦虑自评量表(SAS)〕、心理应激反应(收缩压、舒张压及心率),并统计两组产后并发症情况与母婴结局。结果干预后两组HbA1c、FPG及2hPG水平明显下降,且观察组低于对照组,差异有统计学意义(P<0.05)。干预后两组SDS和SAS评分均下降,且观察组低于对照组,差异有统计学意义(P<0.05)。干预后两组收缩压、舒张压及心率均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者产后出血、胎盘早剥、新生儿窒息及胎儿窘迫发生率均低于对照组,早产率、剖宫产率及并发症发生率均低于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论双C疗法联合循证护理能有效控制GDM合并妊娠期高血压患者的血糖、血压水平,缓解患者负性情绪,更有助于获得满意的母婴结局,临床应用价值更高。

Objective To analyze the effects of Continuous Subcutaneous Insulin Infusion and Continuous Glucose Monitoring System(double-C)therapy combined with evidence-based nursing on psychological stress,complications and maternal and infant outcomes in patients with Gestational Diabetes Mellitus(GDM)complicated with gestational hypertension.Methods A total of 176 patients with GDM complicated with gestational hypertension admitted to the hospital from January 2020 to May 2022 were selected,and divided into observation group(evidence-based nursing,n=91)and control group(conventional nursing,n=85)according to different nursing methods.Both groups were treated with double C therapy.The blood glucose levels〔Fasting Plasma Glucose(FPG),Two Hours Postprandial Blood Glucose(2hPG)and Glycosylated Hemoglobin A1c(HbA1c)〕of the two groups before and after treatment were compared,and the emotional state〔Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS)〕,psychological stress response(systolic blood pressure,diastolic blood pressure and heart rate)of the two groups were compared.The postpartum complications and maternal and infant outcomes of the two groups were analyzed.Results After intervention,the levels of HbA1c,FPG and 2hPG in the two groups were significantly decreased,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).Compared with before intervention,the SDS and SAS scores of the two groups decreased after intervention,and the SDS and SAS scores of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).Compared with before intervention,the systolic blood pressure,diastolic blood pressure and heart rate of the two groups were reduced after intervention,and the systolic blood pressure,diastolic blood pressure and heart rate of the observation group were lower than the control group,and the differences were statistically significant(P<0.05).The rates of postpartum hemorrhage,placental abruption,neonatal asphyxia and fetal distress in observation group were lower than those in control group,and the rates of premature delivery,cesarean section and complications in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions Double-C therapy combined with evidence-based nursing can effectively control the blood sugar and blood pressure levels of GDM patients with pregnancy-induced hypertension,relieve the negative emotions of patients,and contribute to satisfactory maternal and infant outcomes,with higher clinical application value.