杜大千

【摘要】 目的：探讨给予妊娠期糖尿病（GDM）患者限能量膳食（CRD）方案联合低强度连续运动在血糖控制中的应用效果。方法：选取2022年6月—2023年6月北京怀柔医院收治的GDM患者共计350例，以干预方法的不同分成研究组（175例）与对照组（175例），对照组给予常规干预，研究组给予CRD方案联合低强度连续运动干预，比较两组血糖水平、血脂水平、胰岛素使用情况、分娩方式、母婴结局及生活质量。结果：干预后两组糖化血红蛋白（HbA1c）、餐后2 h血糖（2 h PG）、空腹血糖（FPG）水平均下降，研究组均较对照组低，差异均有统计学意义（P<0.05）；干预后两组总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）水平均下降，研究组均较对照组低，差异均有统计学意义（P<0.05）；研究组胰岛素使用率、剖宫产率均较对照组低，差异均有统计学意义（P<0.05）；研究组不良母婴结局发生率21.71%（38/175）较对照组的33.71%（59/175）低，差异有统计学意义（P<0.05）；干预后两组糖尿病特异性生存质量量表（DSQL）评分均下降，研究组较对照组低，差异均有统计学意义（P<0.05）。结论：给予GDM患者CRD方案联合低强度连续运动，能够调节血糖、血脂水平，改善胰岛素使用情况，降低剖宫产率、不良母婴结局发生率，提高患者生活质量。

【关键词】 妊娠期糖尿病 限能量膳食 低强度连续运动 血糖控制 母婴结局

Application of Calorie Restrict Diet and Low-intensity Continuous Exercise in Blood Glucose Control of Patients with Gestational Diabetes Mellitus/DU Daqian. //Medical Innovation of China， 2024， 21（15）： -110

[Abstract] Objective： To explore the application of calorie restrict diet （CRD） and low-intensity continuous exercise in blood glucose control in patients with gestational diabetes mellitus （GDM）. Method： A total of 350 GDM patients from June 2022 to June 2023 who were admitted in Beijing Huairou Hospital were selected and divided into the study group （175 cases） and the control group （175 cases） by different intervention methods. The control group received routine intervention， the study group received CRD regimen and low-intensity continuous exercise intervention. Blood glucose levels， lipid levels， insulin use， delivery methods， maternal and infant outcomes， and quality of life in both groups were compared. Result： After intervention， the glycated hemoglobin （HbA1c）， postprandial 2-hour blood glucose （2 h PG） and fasting plasma glucose （FPG） levels in both groups were decreased， and in comparision of the control group， those in the study group were lower， the differences were statistically significant （P<0.05）. After intervention， the total cholesterol （TC）， triglycerides （TG） and low-density lipoprotein cholesterol （LDL-C） levels in both groups were decreased， and in comparision of the control group， those in the study group were lower， the differences were statistically significant （P<0.05）. In comparision of the control group， the insulin use rate and cesarean section rate in the study group were lower， the differences were statistically significant （P<0.05）. The incidence of adverse maternal and infant outcomes in the study group [21.71% （38/175）] was lower than that of the control group [33.71% （59/175）]， the difference was statistically significant （P<0.05）. After the intervention， diabetes specific quality of life scale （DSQL） scores in both groups were decreased， and in comparision of the control group， that in the study group was lower， the differences were statistically significant （P<0.05）. Conclusion： The combination of CRD regimen and low-intensity continuous exercise can regulate blood glucose and lipid levels， improve insulin use， reduce cesarean section rates， incidence of adverse maternal and infant outcomes， and improve the quality of life of GDM patients.

[Key words] Gestational diabetes mellitus Calorie restrict diet Low intensity continuous exercise Blood glucose control Maternal and infant outcomes

First-author's address： Department of Obstetrics and Gynecology， Beijing Huairou Hospital， Beijing 101400， China

doi：10.3969/j.issn.1674-4985.2024.15.025

妊娠期糖尿病（GDM）对母婴健康造成的危害较大，患者妊娠前糖代谢正常，但妊娠后受到胎盘生乳素、胎盘胰岛素酶、雌激素等抗胰岛素样物质的影响，机体糖代谢紊乱，出现血糖水平升高的情况[1]。为更好地保护母婴安全，需要积极采取血糖控制措施，常规干预方案包含饮食调节、规律运动等，能够在一定程度上改善患者糖脂代谢，但见效较慢，部分患者的血糖水平仍不达标[2]。限能量膳食（CRD）方案能够合理限制患者对碳水化合物的摄入量，模拟饥饿状态，使机体以蛋白质、脂肪等物质作为能量来源，改善胰岛素分泌量和敏感性[3]。GDM患者处于妊娠状态，不宜进行剧烈的运动训练，而低强度连续运动充分考虑到该特点，指导患者进行不间断、低强度的体育锻炼行为，能够使机体得到均衡的良性刺激[4]。本研究对350例GDM患者进行回顾性分析，旨在探讨CRD方案联合低强度连续运动在血糖控制中的应用，详情如下。……