CAJ | 학술논문

目的：评价临床护理路径在初诊妊娠期糖尿病（GDM）患者中的临床应用效果。方法选择2012年5月—2013年7月入住我科的初诊 GDM 患者100例，采用随机数字表法分为对照组40例和观察组60例。对照组患者采用常规护理，观察组患者根据 GDM 临床护理路径进行护理。检测两组患者入院第1 d 及出院前1 d 的空腹血糖（FPG）、空腹胰岛素（FINS）水平，并计算胰岛素抵抗指数（HOMA - IR）；调查两组患者 GDM 相关知识掌握程度、护理工作满意度，统计其住院天数和住院费用。同时选取我科护士60例，调查其对两种护理方法的认同感。结果两组患者入院第1 d FPG、FINS 水平及 HOMA - IR 比较，差异均无统计学意义（P >0,05）；观察组患者出院前1 d FPG及 HOMA - IR 低于对照组（P <0,05），而出院前1 d FINS 水平比较，差异无统计学意义（P >0,05）。观察组患者住院天数和住院费用少于对照组，GDM 相关知识掌握程度和护理工作满意度高于对照组（P <0,05）。护士认同感：两种护理方法在“增加护理工作量”方面比较，差异无统计学意义（P >0,05）；GDM 临床护理路径“增加护患沟通”“减少护患纠纷”效果优于常规护理（P <0,01）。结论临床护理路径有助于改善 GDM 患者血糖控制和胰岛素抵抗，缩短住院时间，降低住院费用，且不增加护理工作量，可提高患者 GDM 相关知识掌握程度和护理工作满意度，减少护患纠纷。
목적：평개림상호리로경재초진임신기당뇨병（GDM）환자중적림상응용효과。방법선택2012년5월—2013년7월입주아과적초진 GDM 환자100례，채용수궤수자표법분위대조조40례화관찰조60례。대조조환자채용상규호리，관찰조환자근거 GDM 림상호리로경진행호리。검측량조환자입원제1 d 급출원전1 d 적공복혈당（FPG）、공복이도소（FINS）수평，병계산이도소저항지수（HOMA - IR）；조사량조환자 GDM 상관지식장악정도、호리공작만의도，통계기주원천수화주원비용。동시선취아과호사60례，조사기대량충호리방법적인동감。결과량조환자입원제1 d FPG、FINS 수평급 HOMA - IR 비교，차이균무통계학의의（P >0,05）；관찰조환자출원전1 d FPG급 HOMA - IR 저우대조조（P <0,05），이출원전1 d FINS 수평비교，차이무통계학의의（P >0,05）。관찰조환자주원천수화주원비용소우대조조，GDM 상관지식장악정도화호리공작만의도고우대조조（P <0,05）。호사인동감：량충호리방법재“증가호리공작량”방면비교，차이무통계학의의（P >0,05）；GDM 림상호리로경“증가호환구통”“감소호환규분”효과우우상규호리（P <0,01）。결론림상호리로경유조우개선 GDM 환자혈당공제화이도소저항，축단주원시간，강저주원비용，차불증가호리공작량，가제고환자 GDM 상관지식장악정도화호리공작만의도，감소호환규분。
Objective To observe application and effect of clinical nursing pathway intervention in newly diagnosed gestational diabetes mellitus(GDM), Methods A total of 100 GDM inpatients admitted to our department from May 2012 to July 2013 were randomly divided into control group(n = 40)and observation group(n = 60), The control group was given con-ventional nursing model,while the observation group was given the clinical nursing pathway, Fasting plasma glucose(FPG)and fasting insulin(FINS)were monitored and the insulin resistance index(HOMA - IR)was calculated, The level of the patients' GDM knowledge,the satisfaction on nursing quality were investigated,and the days and expenses in hospital were also coun-ted, 60 nurses in our hospital were selected to study the sense of identity of the two nursing methods,and the clinical application effect were compared between the two groups, Results On the first day of hospitalization,the FPG,FINS and HOMA - IR be-tween the two groups showed no statistically significant difference(P > 0, 05), One day before discharge from hospital,the FPG and HOMA - IR in observation group were lower than those of control group(P < 0, 05),but the FINS showed no statistically significant difference(P > 0, 05), The days of hospitalization and expenses of the observation group were less than the control group,and the GDM knowledge level and satisfaction level on nursing quality in observation group were higher than those of con-trol group(P < 0, 05), The two nursing models showed no statistically significant difference in terms of increasing the amount of work(P > 0, 05),but the clinical nursing pathway was better in enhancing the communication between nurses and patients and reducing disputes(P < 0, 01), Conclusion The application of clinical nursing pathway is conducive to improving insulin resist-ance and lowering fasting blood glucose of GDM patients, It can also shorten the length of time in hospital and decrease the expense in hospital,as well as elevate the diabetes's knowledge level among GDM patients and improve the relationship between nurses and patients and the satisfaction on nursing quality.