李英

[摘要] 目的 探討King达标理论用于妊娠糖尿病孕妇院外管理的临床效果。 方法 选取2015年6月～2016年6月我院收治的100例妊娠糖尿病孕妇，按照随机数字表法将其平均分为对照组及观察组，每组50例。对照组患者采用一般护理模式指导其院外管理，观察组患者采用King达标理论指导其院外管理。观察并记录两组患者入院时一般情况（包括年龄、孕周、妊娠类型、诊断、体重指数、文化程度、医疗形式、月收入等）、干预前后血糖控制情况、HbAlc以及分娩结局等。 结果 两组孕妇年龄、孕周、妊娠类型、诊断、体重指数、文化程度、医疗形式、月收入比较，差异无统计学意义（P>0.05），具有可比性。两组孕妇干预前血糖控制情况比较无明显差异（P>0.05），两组孕妇干预前后血糖控制水平比较差异明显（P<0.05），随着干预的进行，两组孕妇血糖控制情况均较前改善，但观察组孕妇血糖控制水平明显优于对照组，差异具有统计学意义（P<0.05）。干预前两组患者HbAlc比较无明显差异（P>0.05），干预后两组患者HbAlc明显降低（P<0.05），但观察组降低程度明显大于对照组，差异有统计学意义（P<0.05）。两组孕妇早产儿、高胆红素血症、羊水过多发生情况比较无明显差异（P>0.05），两组孕妇妊娠期高血压、剖宫产、胎膜早破、巨大儿发生情况明显少于对照组，差异有统计学意义（P<0.05）。 结论 King达标理论能有效改善妊娠期糖尿病患者院外血糖控制情况，改善分娩结局，值得临床广泛推广。

[关键词] 妊娠糖尿病；院外管理；分娩结局；血糖控制

[中图分类号] R473.71 [文献标识码] B [文章编号] 1673-9701（2018）07-0157-04

[Abstract] Objective To explore and analyze the clinical effect of King's compliance theory on the management outside the hospital for pregnant women with gestational diabetes mellitus. Methods A total of 100 pregnant women with gestational diabetes who were admitted to our hospital from June 2015 to June 2016 were selected. In accordance with the random number table method， the patients were evenly divided into the control group and the observation group， with 50 cases in each group. Patients in the control group were given general nursing mode to guide their management outside the hospital， and patients in the observation group were given King's compliance theory to guide their management outside the hosptial. The general situation upon admission to the hospital（including age， gestational weeks， type of pregnancy， diagnosis， body mass index， educational level， medical form， monthly income， etc.）， blood glucose control before and after intervention， HbAlc and delivery outcomes of two groups of patients were observed and recorded. Results The age， gestational weeks， type of pregnancy， diagnosis， body mass index， educational level， medical forms， monthly income in both groups of pregnancy women were not significantly different（P>0.05）， which were comparable. The blood glucose control was not significantly different before intervention in both groups （P>0.05）， and the blood glucose control level was significantly different in the two groups before and after intervention （P<0.05）. With the intervention， the blood glucose control was improved compared with that before intervention in both groups. However， the blood glucose control level in the observation group was significantly better than that in the control group（P<0.05）， with statistical significance. There was no significant difference in HbAlc between the two groups before intervention（P>0.05）， and HbAlc in both groups was significantly lower after intervention（P<0.05）. However， the decreasing degree in the observation group was significantly higher than that in the control group（P<0.05）， with statistical significance. The incidence of premature infants， hyperbilirubinemia and polyhydramnios were not significantly different between the two groups（P>0.05）. The incidence of gestational hypertension， Cesarean section， premature rupture of membranes and macrosomia in both groups were significantly lower than those in the control group（P<0.05）， with statistical significance. Conclusion The King's compliance theory can effectively improve the glycemic control outside the hospital in the patients with gestational diabetes mellitus and improve the outcome of delivery. It is worthy of extensive clinical promotion.

[Key words] Pregnancy-induced diabetes mellitus； Management outside the hospital； Pregnancy outcome； Blood sugar control

妊娠期糖尿病是指妊娠前糖代谢正常或有潜在糖耐量减退，妊娠期才出现的糖尿病。糖尿病孕妇中80%以上为GDM，糖尿病合并妊娠者不足20%[1-2]。GDM患者糖代谢多数于产后能恢复正常，但将来患2型糖尿病机会增加。糖尿病孕妇的临床经过复杂，其不仅会影响孕妇营养代谢，而且会影响产妇分娩结局。因此，妊娠期间有效控制患者血糖，减少血糖波动对于孕妇及胎儿的健康具有重要的意义。研究[3]发现，住院期间患者血糖控制较良好，但出院后部分患者血糖控制水平波动较大。胰岛……