CAJ | 학술논문

目的评价在社区实施以家庭为单位的健康管理对妊娠糖尿病(GDM)患者及其子代的影响.方法 2009年1月至2012年12月,选择枣庄市立医院新城社区84例单胎GDM患者,随机分为管理组和对照组.对两组孕妇均建立孕期健康管理档案,组建社区GDM健康管理团队,实施系统的健康教育、干预和随访至妊娠结束.管理组接受以家庭为单位的健康管理.对照组接受常规健康教育、干预、随访.比较两组孕妇入组时(孕24～28周)与分娩前末次血糖、血脂、血压、体质指数的变化及妊娠结局,分析以家庭为单位的健康管理的效果.结果管理组和对照组GDM孕妇各42例.两组基线数据差异无统计学意义,具有可比性.两组孕妇分娩前末次空腹血糖、餐后2h血糖、收缩压、舒张压、BMI、孕期体重增加、总胆固醇、三酰甘油、低密度脂蛋白胆固醇比较,管理组均明显低于对照组,高密度脂蛋白胆固醇比较,管理组高于对照组,差异有统计学意义(t值分别为5.81、2.28、3.14、2.41、5.17、4.97、7.81、2.39、3.39、2.02,P＜0.05)；两组羊水过多、胎膜早破、妊娠期高血压疾病、顺产、剖宫产、巨大儿、新生儿低血糖差异有统计学意义(x2分别为4.61、4.48、4.48、4.94、4.27、4.48、4.76,P＜0.05)；管理后管理组健康行为(均衡膳食、规律运动、正确用药、规范监测、按时复诊、高低血糖处理、情绪管理)明显优于对照组,差异有统计学意义(x2分别为5.61、4.76、5.27、5.73、4.48、5.19、4.20,P＜0.05).结论对社区妊娠糖尿病患者实施以家庭为单位的健康管理,可以提高妊娠糖尿病患者的健康行为,改善代谢状况,改善妊娠糖尿病患者母婴结局.
목적 평개재사구실시이가정위단위적건강관리대임신당뇨병(GDM)환자급기자대적영향.방법 2009년1월지2012년12월,선택조장시립의원신성사구84례단태GDM환자,수궤분위관리조화대조조.대량조잉부균건립잉기건강관리당안,조건사구GDM건강관리단대,실시계통적건강교육、간예화수방지임신결속.관리조접수이가정위단위적건강관리.대조조접수상규건강교육、간예、수방.비교량조잉부입조시(잉24～28주)여분면전말차혈당、혈지、혈압、체질지수적변화급임신결국,분석이가정위단위적건강관리적효과.결과 관리조화대조조GDM잉부각42례.량조기선수거차이무통계학의의,구유가비성.량조잉부분면전말차공복혈당、찬후2h혈당、수축압、서장압、BMI、잉기체중증가、총담고순、삼선감유、저밀도지단백담고순비교,관리조균명현저우대조조,고밀도지단백담고순비교,관리조고우대조조,차이유통계학의의(t치분별위5.81、2.28、3.14、2.41、5.17、4.97、7.81、2.39、3.39、2.02,P＜0.05)；량조양수과다、태막조파、임신기고혈압질병、순산、부궁산、거대인、신생인저혈당차이유통계학의의(x2분별위4.61、4.48、4.48、4.94、4.27、4.48、4.76,P＜0.05)；관리후관리조건강행위(균형선식、규률운동、정학용약、규범감측、안시복진、고저혈당처리、정서관리)명현우우대조조,차이유통계학의의(x2분별위5.61、4.76、5.27、5.73、4.48、5.19、4.20,P＜0.05).결론 대사구임신당뇨병환자실시이가정위단위적건강관리,가이제고임신당뇨병환자적건강행위,개선대사상황,개선임신당뇨병환자모영결국.
Objective To evaluate the effect of household-based health management model on community patients with gestational diabetes.Methods Eighty-four singleton pregnant women with diabetes who visited New City Community Healthcare Center of Zaozhuang Municipal Hospital from January 2009 to December 2012 were randomly assigned to the management group (n =42) and the control group (n =42).The pregnant women in the management group accepted household-based health management,and the pregnant women in the control group accepted conventional health education,intervention,and followup.Blood glucose,lipid profiles,blood pressure,body mass index (BMI) and pregnancy outcomes were compared between the two groups.Results There were no significant different of clinical characteristics between the two groups at baseline.Right before delivery,fasting plasma glucose,2 h postprandial blood glucose,blood pressure,childbirth BMI,pregnancy weight gain,total cholesterol,triglyceride and low-density lipoprotein cholesterol of the management group were significantly lower than those of the control group (t values were 5.81,2.28,3.14,2.41,5.17,4.97,7.81,2.39 and 3.39,respectively; all P ＜0.05),however high-density lipoprotein cholesterol was relatively higher (t =2.02,P ＜ 0.05).Polyhydramnios,premature rupture of membranes,hypertensive disorders in pregnancy,natural labour,cesarean section,fetal macrosomia and neonatal hypoglycemia were found significantly different between the two groups (x2 values were 4.61,4.48,4.48,4.94,4.27,4.48 and 4.76,respectively; all P ＜ 0.05).Health behavior of the management group was significantly improved following the intervention (for balanced diet,regular exercise,proper medication,standardized monitoring,timely referral,high and low blood sugar treatment and emotional management,x2 values were 5.61,4.76,5.27,5.73,4.48,5.19 and 4.20,respectively; all P ＜ 0.05).Conclusion Household-based health management could improve health behavior,metabolic status and maternal or neonatal outcomes of community patients with gestational diabetes.