陈金秀 魏小梨 单月玲

[摘要]目的 探讨综合护理干预在妊娠期糖尿病（GDM）孕妇中的应用效果。方法 选取2017年1月～2018年12月我院收治的800例GDM孕妇作为研究对象，按照随机法分为对照组（n=400）和观察组（n=400）。对照组采用常规护理方法，观察组采用综合护理干预方法。比较两组的血糖漏测率、母婴分离率、剖宫产率及新生儿并发症。结果 观察组血糖漏测率、母婴分离率及剖宫产率低于对照组，差异均有统计学意义（P<0.05）;观察组的早产儿、新生儿窒息及巨大儿发生率低于对照组，差异均有统计学意义（P<0.05）;观察组护理总满意度为92.8%，高于对照组的83.5%，差异有统计学意义（P<0.05）。结论 综合護理干预可明显降低GDM孕妇血糖漏测率，提高血糖监测依从性，同时也降低了剖宫产率和母婴分离率，减少新生儿并发症，改善了妊娠结局，既减轻了经济负担，也提高了GDM孕妇满意度。

[关键词]综合干预;妊娠期糖尿病;应用;妊娠结局

[Abstract] Objective To explore the application effect of comprehensive nursing intervention in pregnant women with gestational diabetes mellitus （GDM）. Methods Altogether 800 cases pregnant women with GDM admitted to the our hospital from January 2017 to December 2018 were selected as research objects. They were randomly divided into control group （n=400） and observation group （n=400）. The control group adopted conventional nursing method， and the observation group adopted comprehensive nursing intervention method. Blood glucose leakage rate， maternal and infant separation rate， cesarean section rate and neonatal complications were compared between the two groups. Results The blood glucose leakage rate， maternal and child separation rate and cesarean section rate in the observation group were lower than those in the control group， with statistical differences （P<0.05）. The incidence of premature， neonatal asphyxia and macrosomia in the observation group were lower than those in the control group， with statistical differences （P<0.05）. The total satisfaction of the observation group was 92.8%， higher than that of the control group （83.5%）， and the difference was statistically significant （P<0.05）. Conclusion Comprehensive intervention can significantly reduce the rate of blood glucose leakage in GDM pregnant women， improve the compliance of blood glucose monitoring， reduce the rate of cesarean section and maternal and infant separation， reduce neonatal complications， improve the pregnancy outcome， and it does not only reduce the economic burden， but also improve the satisfaction of GDM pregnant women.

[Key words] Comprehensive intervention; Gestational diabetes; Application; Pregnancy outcomes

妊娠期糖尿病（GDM）指妊娠前糖代谢正常，妊娠后才出现的糖尿病[1]。孕期胎盘分泌人胎盘催乳素、胎盘胰岛素酶，尤其肿瘤坏死因子等物质均可拮抗胰岛素的降糖作用，随着妊娠周数增加，拮抗胰岛素作用增强，若胰岛β细胞无法代偿这一作用，则不能维持正常血糖水平[2]。随着人们生活水平的提高，近年来GDM有逐年增长的趋势，严重影响母胎安全，其基本的病理生理变化为胰岛素相对或绝对不足所导致的糖、蛋白质、脂肪、水及电解质等代谢失调，以血糖升高为特点。在血糖控制不理想的GDM患者中，孕妇高血糖会导致胎儿血糖浓度升高，后者刺激胎儿胰岛分泌胰岛素增加，使胎儿合成代谢旺盛，胎儿生长发育过快，巨大儿发生率增加。胎儿代谢增加的同时机体对氧气需要量也增加，可引起胎儿慢性缺氧状态[3]。血糖监测是GDM管理的重要内容。但由于各种因素影响，孕妇监测血糖依从性不高。我院是本地区的重症孕产妇救治中心，收治GDM患者较多，提高孕妇血糖监测依从性，降低血糖漏测率，改善围生结局，是产科工作的重要课题。本研究通过多种措施干预，提高孕妇血糖监测依从性改善妊娠结局方面取得一定效果，现报道如下。