CAJ | 학술논문

目的：探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）患者实施产前胰岛素泵短期强化综合干预对血糖控制和妊娠结局的影响。方法2010年6月-2013年6月符合研究标准的GDM产前胰岛素强化治疗的64例患者随机分成综合干预组和常规护理组各32例。常规护理组患者给予常规护理干预，包括饮食与运动指导，相关知识宣教，胰岛素泵治疗的优越性介绍，胰岛素泵安装与护理以及并发症的防范。综合干预组患者在常规护理干预的基础上，给予短期强化综合干预，包括按照应用上肢功率计运动，举办沙龙活动和实施胰岛素泵个体化技术培训。观察两组患者遵医行为，血糖控制情况，记录低血糖、酮症酸中毒和皮肤感染发生情况，以及妊娠高血压综合征、早产、巨大儿等妇科、儿科、产科并发症情况。结果综合干预组遵医行为显著优于常规护理组（P＜0.05），两组血糖达标时间差异无统计学意义，但综合干预组日均胰岛素用量显著低于常规护理组（P＜0.05）。综合干预组产妇低血糖症状发生率显著均低于常规护理组（P＜0.05），两组产妇妊娠高血压综合征、早产及胎儿窘迫等差异无统计学意义。两组新生儿并发症差异无统计学意义。结论 GDM产前胰岛素泵短期强化治疗综合干预显著增强患者的遵医行为，有助平稳控制产前高血糖，可减少胰岛素用量，有效控制产妇低血糖症状发生。
목적：탐토임신기당뇨병（gestational diabetes mellitus，GDM）환자실시산전이도소빙단기강화종합간예대혈당공제화임신결국적영향。방법2010년6월-2013년6월부합연구표준적GDM산전이도소강화치료적64례환자수궤분성종합간예조화상규호리조각32례。상규호리조환자급여상규호리간예，포괄음식여운동지도，상관지식선교，이도소빙치료적우월성개소，이도소빙안장여호리이급병발증적방범。종합간예조환자재상규호리간예적기출상，급여단기강화종합간예，포괄안조응용상지공솔계운동，거판사룡활동화실시이도소빙개체화기술배훈。관찰량조환자준의행위，혈당공제정황，기록저혈당、동증산중독화피부감염발생정황，이급임신고혈압종합정、조산、거대인등부과、인과、산과병발증정황。결과종합간예조준의행위현저우우상규호리조（P＜0.05），량조혈당체표시간차이무통계학의의，단종합간예조일균이도소용량현저저우상규호리조（P＜0.05）。종합간예조산부저혈당증상발생솔현저균저우상규호리조（P＜0.05），량조산부임신고혈압종합정、조산급태인군박등차이무통계학의의。량조신생인병발증차이무통계학의의。결론 GDM산전이도소빙단기강화치료종합간예현저증강환자적준의행위，유조평은공제산전고혈당，가감소이도소용량，유효공제산부저혈당증상발생。
Objective To evaluate the effect of integrated intervention for patients with gestational diabetes mellitus (GDM) undergoing predelivery insulin pump intensive therapy on glycemic control and perinatal outcome. Methods Totally 64 patients with GDM undergoing insulin pump intensive therapy were randomly divided into integrated intervention (II) group and routine nursing (RN) group from June 2010 to June 2013. Integrated interventions included GDM diet and upper limbs activity by MOTO med viva2 adaptive ergometer, education of harm to pregnant women and neonates from GDM, advantages of pump therapy, pumps managing training, complication prevention. GDM salons were hold aperiodically, and the individual normative technical training were implemented whenever necessary. Treatment compliance, time for successful treatment, daily insulin dosage, maternal and neonatal complications were assessed. Results Treatment compliance was significantly better in group II than that in group RN ( P<0.05). Both the daily insulin dosage and the incidence of hypoglycemia were significantly less in group II than those in group RN ( P<0.05). Conclusion Through integrated intervention of insulin pump therapy, patients have better treatment compliance, while with less insulin dosage, and the hypoglycemia is prevented and controlled effectively.