摘要
目的探讨罗伊适应模式(RAM)对妊娠期糖尿病(GDM)患者血糖控制和妊娠结局的影响。方法选取2018年1~9月同济大学附属第一妇婴保健院产科门诊首次确诊GDM的的患者301例。根据抽签结果,分为对照组(154例)和干预组(147例)。对照组进行常规医疗干预,干预组在对照组的基础上联合RAM进行干预。比较两组孕早期体重指数(BMI),孕期体重增加值,干预8周后空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA1c)水平;比较两组治疗方法、妊娠并发症和妊娠结局。结果两组孕早期BMI比较,差异无统计学意义(P> 0.05)。干预8周后,干预组孕期体重增加值、HbA1c水平低于对照组,差异有统计学意义(P <0.05);两组空腹血糖、餐后2 h血糖比较,差异无统计学意义(P> 0.05)。两组血酮阳性例数比较,差异无统计学意义(P> 0.05);干预组使用胰岛素治疗例数及孕期HbA1c高于6%例数少于对照组,差异有统计学意义(P <0.05)。两组产前发热、羊水过多、产后出血、早产、胎儿窘迫和新生儿窒息发生率比较,差异无统计学意义(P> 0.05);干预组妊娠期高血压疾病、巨大儿、新生儿高胆红素血症发生率低于对照组,差异有统计学意义(P <0.05)。结论 RAM干预可降低GDM患者的血糖水平,减少其胰岛素的使用、降低妊娠期并发症的发生,并改善妊娠结局,值得推广。
Objective To investigate the effect of Roy′s adaptation model on glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus(GDM). Methods From January to September 2018, 301 cases who diagnosed GDM for the first time in the First Maternity and Infant Hospital Affiliated to Tongji University were seletced.They were divided into control group(154 cases) and intervention group(147 cases) according to the result of lottery.Control group was treated with routine medical intervention, and intervention group was treated with Roy′s adaptation model(RAM) on the basis of control group. Body mass index(BMI) in early pregnancy, weight gain during pregnancy and fasting blood glucose, 2 h postprandial blood glucose, and HbA1 clevel after 8 weeks of intervention were compared between two groups. Treatment, pregnancy complications and pregnancy outcomes were compared between two groups.Results There was no significant difference in BMI between two groups in early pregnancy(P > 0.05). After 8 weeks of intervention, pregnancy weight gain and HbA1 clevels in intervention group were lower than those in control group, with statistically significant differences(P < 0.05). There was no significant difference in fasting blood glucose and 2 h postprandial blood glucose between two groups(P > 0.05). There was no significant difference in the number of blood ketone positive cases between the two groups(P > 0.05). The number of cases treated with insulin and HbA1 chigher than6% in pregnancy in intervention group were less than those in control group, with statistically significant differences(P <0.05). There was no statistically significant difference in the incidence of prenatal fever, excess amniotic fluid, postpartum hemorrhage, premature delivery, fetal distress and neonatal asphyxia between the two groups(P > 0.05). The incidence of hypertension during pregnancy, macromacroia and hyperbilirubinemia in neonates in intervention group was lower than that in control group, with statistically significant differences(P < 0.05). Conclusion RAM intervention can reduce blood glucose level, reduce the use of insulin, reduce the occurrence of pregnancy complications, and improve pregnancy outcome in GDM patients, which is worthy of promotion.
作者
张逸
潘慧蓉
李艳
ZHANG Yi;PAN Huirong;LI Yan(Department of Outpatient and Emergency,the First Maternity and Infant Hospital Affiliated to Tongji University,Shanghai 201204,China)
出处
《中国医药导报》
CAS
2020年第12期116-119,共4页
China Medical Herald
关键词
罗伊适应模式
妊娠期糖尿病
并发症
妊娠结局
Roy′s adaptation mode
Gestational diabetes mellitus
Complication
Pregnancy outcome
