King達標理論用于妊娠糖尿病孕婦院外管理的臨床效果

李英

[摘要] 目的 探討King達標理論用于妊娠糖尿病孕婦院外管理的臨床效果。 方法 選取2015年6月～2016年6月我院收治的100例妊娠糖尿病孕婦，按照隨機數(shù)字表法將其平均分為對照組及觀察組，每組50例。對照組患者采用一般護理模式指導其院外管理，觀察組患者采用King達標理論指導其院外管理。觀察并記錄兩組患者入院時一般情況（包括年齡、孕周、妊娠類型、診斷、體重指數(shù)、文化程度、醫(yī)療形式、月收入等）、干預前后血糖控制情況、HbAlc以及分娩結(jié)局等。 結(jié)果 兩組孕婦年齡、孕周、妊娠類型、診斷、體重指數(shù)、文化程度、醫(yī)療形式、月收入比較，差異無統(tǒng)計學意義（P>0.05），具有可比性。兩組孕婦干預前血糖控制情況比較無明顯差異（P>0.05），兩組孕婦干預前后血糖控制水平比較差異明顯（P<0.05），隨著干預的進行，兩組孕婦血糖控制情況均較前改善，但觀察組孕婦血糖控制水平明顯優(yōu)于對照組，差異具有統(tǒng)計學意義（P<0.05）。干預前兩組患者HbAlc比較無明顯差異（P>0.05），干預后兩組患者HbAlc明顯降低（P<0.05），但觀察組降低程度明顯大于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組孕婦早產(chǎn)兒、高膽紅素血癥、羊水過多發(fā)生情況比較無明顯差異（P>0.05），兩組孕婦妊娠期高血壓、剖宮產(chǎn)、胎膜早破、巨大兒發(fā)生情況明顯少于對照組，差異有統(tǒng)計學意義（P<0.05）。 結(jié)論 King達標理論能有效改善妊娠期糖尿病患者院外血糖控制情況，改善分娩結(jié)局，值得臨床廣泛推廣。

[關鍵詞] 妊娠糖尿病；院外管理；分娩結(jié)局；血糖控制

[中圖分類號] R473.71 [文獻標識碼] B [文章編號] 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謝正常或有潛在糖耐量減退，妊娠期才出現(xiàn)的糖尿病。糖尿病孕婦中80%以上為GDM，糖尿病合并妊娠者不足20%[1-2]。GDM患者糖代謝多數(shù)于產(chǎn)后能恢復正常，但將來患2型糖尿病機會增加。糖尿病孕婦的臨床經(jīng)過復雜，其不僅會影響孕婦營養(yǎng)代謝，而且會影響產(chǎn)婦分娩結(jié)局。因此，妊娠期間有效控制患者血糖，減少血糖波動對于孕婦及胎兒的健康具有重要的意義。研究[3]發(fā)現(xiàn)，住院期間患者血糖控制較良好，但出院后部分患者血糖控制水平波動較大。胰島……