刘小阳 廖平英 易鹏 温瑶 谈瑞娟 方园

【摘要】 目的：探究妊娠期糖尿病（gestational diabetes mellitus，GDM）患者半日门诊管理效果，并讨论半日门诊对GDM患者和围生儿结局的影响。方法：选取2018年1月-2019年4月在本院诊断为GDM的患者200例，按照个人意愿分为试验组100例和对照组100例，试验组参加半日门诊管理，对照组行常规管理。试验组半日门诊管理前与半日门诊管理1个月后进行GDM相关知识问卷问答;检测两组入组前和妊娠晚期的空腹血糖和餐后2 h血糖;对比两组妊娠期高血压疾病、巨大儿、羊水异常、早产、胎膜早破发生情况。结果：试验组半日门诊管理1个月后知识知晓率与半日门诊管理前比较，差异均有统计学意义（P<0.05）。两组入组前空腹血糖和餐后2 h血糖比較，差异均无统计学意义（P>0.05）;试验组妊娠晚期餐后2 h血糖低于对照组（P<0.05）。试验组妊娠期高血压疾病、巨大儿发生率均低于对照组（P<0.05）。结论：妊娠期糖尿病半日门诊管理可以有效地控制GDM孕妇血糖水平，普及糖尿病知识，加强自我血糖监测的主动性，减少孕妇和围生儿并发症，值得推广。

【关键词】 妊娠期糖尿病 半日门诊 妊娠结局 管理

[Abstract] Objective： To investigate the effect of half-day outpatient management in patients with gestational diabetes mellitus （GDM）， and to discuss the effect of half-day outpatients on the outcome of patients and perinatal children. Method： According to the personal wishes， 200 patients with GDM diagnosed in our hospital from January 2018 to April 2019 were divided into the experimental group 100 cases and the control group 100 cases. The experimental group volunteered to participate in GDM half-day outpatient management， and the control group was given routinely managed. Patients in the experimental group were asked to answer questions about the GDM-related knowledge questionnaire before and one month after the half-day outpatient clinic. The fasting blood glucose and 2 h blood glucose of two groups before enrollment and the late pregnancy were detected. The incidence of hypertensive disorder complicating pregnancy， macrosomia， amniotic fluid abnormalities， premature delivery， and premature rupture of membranes in two groups were collected. Result： After 1 month of half-day outpatient management， the knowledge awareness rates of the experimental group compared with that before half-day outpatient management， the differences were statistically significant （P<0.05）. There were no statistical differences between the fasting blood glucose and 2 h postprandial blood glucose in two groups before enrollment （P>0.05）. The 2 h postprandial blood glucose in the experimental group at the late pregnancy was lower than that in the control group （P<0.05）. The incidence of hypertensive disorder complicating pregnancy and macrosomia in the experimental group were lower than those in the control group （P<0.05）. Conclusion： Half-day outpatient management of GDM can effectively control the blood sugar level of GDM patients， popularize diabetes knowledge， strengthen the initiative of self-glycemic monitoring， and reduce complications of pregnant women and perinatal children， which is worth of promoting.

妊娠期糖尿病（gestational diabetes mellitus，GDM）指的是曾经糖代谢正常，而在妊娠期间出现糖代谢异常的疾病，属于妊娠期最常见的疾病之一[1]。近年来，随着国民生活水平的不断提高以及二胎政策的开放，GDM的发生率不断上升，GDM严重影响着孕妇和胎儿的生命健康，而近年来研究发现大多数的孕妇可以通过营养学治疗、运动和改善生活方式来干预血糖使其达到满意水平[2-4]。目前有不少医疗机构开始探索GDM“一日门诊”管理的模式，并取得了不错的效果[5]。但由于本院没有开设营养食堂，不能满足一日门诊管理中给患者提供全天的标准糖尿病膳食体验，以及偏远地区的患者无法长时间留院体验，本院因地制宜，在一日门诊管理的基础上结合现有的医疗资源施行GDM半日门诊管理，取已删除得了不错的效果。……