个性化营养支持对妊娠期糖尿病患者血糖和并发症的影响

邹素珍; 叶琼; 吴淋淋; 倪娟娟

doi:10.16766/j.cnki.issn.1674-4152.002902

个性化营养支持对妊娠期糖尿病患者血糖和并发症的影响

doi: 10.16766/j.cnki.issn.1674-4152.002902

1.
温州医科大学附属第二医院产科，浙江温州 325000
2.
金华市人民医院妇科，浙江金华 321000

基金项目:

浙江省医药卫生科技计划项目 2021KY1184

详细信息

通讯作者:
邹素珍，E-mail：z1099779684@163.com

中图分类号: R714.25
计量
- 文章访问数: 221
- HTML全文浏览量: 90
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-24
- 网络出版日期: 2023-04-19

Evaluation of the efficacy of individualized nutritional guidance on blood glucose and complications in patients with gestational diabetes mellitus

1.
Obstetrics of the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨个性化营养支持对妊娠期糖尿病患者血糖和并发症的影响，为妊娠期糖尿病患者的管理提供参考依据。方法选取2019年6月—2021年12月温州医科大学附属第二医院收治的妊娠期糖尿病患者110例作为研究对象，按照随机数字表法分为对照组(55例)和观察组(55例)。对照组采用常规妊娠期糖尿病方案, 观察组在对照组的基础上实施个性化营养支持。干预4周后，比较2组患者妊娠期糖尿病知识达标率、护理满意度，检测2组患者的空腹血糖和餐后2 h血糖，并比较妊娠期并发症和新生儿并发症情况。结果观察组妊娠期糖尿病知识达标率和护理满意度评分明显优于对照组(均P < 0.05)。观察组空腹血糖和餐后2 h血糖分别为(5.56±0.26)mmol/L、(6.59±0.54)mmol/L，显著低于对照组(5.73±0.30)mmol/L、(7.28±0.69)mmol/L(均P < 0.05)。观察组妊娠期并发症和新生儿并发症发生率分别是14.55%(8/55)、10.91%(6/55)，均低于对照组的38.18%(21/55)、34.55%(19/55)，均P＜0.05。结论对妊娠期糖尿病患者实施个性化营养支持效果优良，能够有效控制血糖水平、减少并发症。
- 个性化营养支持 /
- 妊娠期糖尿病 /
- 血糖 /
- 并发症
Abstract: Objective This study aims to explore the evaluation of the efficacy of individualized nutritional guidance on blood glucose and complications in patients with gestational diabetes mellitus, and to provide a reference for the management of patients with gestational diabetes. Methods A total of 110 patients with gestational diabetes admitted to the Second Hospital of Wenzhou Medical University from June 2019 to December 2021 were randomly divided into control group (n=55) and observation group (n=55), according to the random number table method. The control group received routine gestational diabetes regimen, and the observation group received individualized nutritional guidance on the basis of the control group. After 4 weeks of intervention, the compliance rate of gestational diabetes knowledge attainment and nursing satisfaction of the two groups were compared. Fasting blood glucose and 2-hour postprandial blood glucose in the 2 groups were measured, and the pregnancy complications and neonatal complications in the 2 groups were compared. Results The knowledge attainment rate of gestational diabetes and nursing satisfaction score in the observation group were significantly better than those in the control group (both P < 0.05). Fasting blood glucose and 2-hour postprandial blood glucose in the observation group were (5.56±0.26) mmol/L, (6.59±0.54) mmol/L, respectively, which were significantly lower than those in the control group (5.73±0.30) mmol/L, (7.28±0.69) mmol/L (both P < 0.05). The incidence of pregnancy complications and neonatal complications in the observation group were 14.55% (8/55) and 10.91% (6/55), respectively, which were lower than 38.18% (21/55) and 34.55% (19/55) in the control group (both P < 0.05). Conclusion The effect of individualized nutritional support for patients with gestational diabetes mellitus is excellent, which can effectively control the blood glucose level and reduce complications.
- Personalized nutritional support /
- Gestational diabetes /
- Blood glucose /
- Complication

HTML全文

表 1 2组妊娠期糖尿病患者妊娠期糖尿病知识达标率和护理满意度比较

Table 1. Comparison of attainment rate of gestational diabetes knowledge and nursing satisfaction between the two groups of patients with gestational diabetes

组别	例数	妊娠糖尿病知识达标[例(%)]	护理满意度评分(x±s，分)
观察组	55	53(96.36)	97.23±1.82
对照组	55	46(83.63)	90.75±1.69
统计量		4.949^a	19.349^b
P值		0.026	＜0.001
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组妊娠期糖尿病患者血糖水平比较(x±s, mmol/L)

Table 2. Comparison of blood glucose levels in gestational diabetes mellitus between the two groups(x±s, mmol/L)

组别	例数	空腹血糖		t值	P值	餐后2 h血糖		t值	P值
组别	例数	干预前	干预后	t值	P值	干预前	干预后	t值	P值
观察组	55	6.41±0.44	5.56±0.26	8.755	＜0.001	9.39±0.76	6.59±0.54	14.832	＜0.001
对照组	55	6.38±0.42	5.73±0.30	11.477	＜0.001	9.37±0.73	7.28±0.69	7.381	＜0.001
t值		0.366	3.176			0.141	5.840
P值		0.715	0.002			0.888	0.001

下载: 导出CSV

表 3 2组妊娠期糖尿病患者妊娠期并发症情况比较[例(%)]

Table 3. Comparison of gestational complications of gestational diabetes mellitus between the two groups [cases (%)]

组别	例数	妊娠高血压	羊水异常	感染	产后出血	总发生
观察组	55	4(7.27)	2(3.64)	1(1.82)	1(1.82)	8(14.55)
对照组	55	12(21.82)	5(9.09)	2(3.64)	2(3.64)	21(38.18)
注：2组并发症总发生率比较，χ²=7.914，P=0.005。

下载: 导出CSV

表 4 2组新生儿并发症情况比较[例(%)]

Table 4. Comparison of neonatal complications between the two groups [cases (%)]

组别	例数	巨大儿	早产儿	新生儿窒息	胎儿窘迫	总发生
观察组	55	2(3.64)	3(5.45)	0	1(1.82)	6(10.91)
对照组	55	9(16.36)	3(5.45)	3(5.45)	4(7.27)	19(34.55)
注：2组并发症总发生率比较，χ²=8.748，P=0.003。

下载: 导出CSV

参考文献(19)

[1]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志, 2022, 57(1): 3-12. Obstetrics group of obstetrics and Gynecology branch of Chinese Medical Association, Perinatal medicine branch of Chinese Medical Association, Pregnancy with diabetes Professional Committee of China maternal and Child Health Association. Guideline of diagnosis and treatment of hyperglycemia in pregnancy (2022)[Part one][J]. Chinese Journal of Obstetrics and Gynecology, 2022, 57(1): 3-12.
[2]	陈露露, 石海君, 漆洪波. 加拿大妇产科医师协会"妊娠期糖尿病指南(2019)"要点解读[J]. 实用妇产科杂志, 2021, 37(1): 23-27. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202101009.htm CHEN L L, SHI H J, QI H B. Interpretation of the key points of the "pregnancy diabetes guidelines (2019)" of the Canadian Association of Obstetricians and gynecologists[J]. Journal of Practical Obstetrics and Gynecology, 2021, 37(1): 23-27. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202101009.htm
[3]	李卫芹, 米杰. 妊娠期糖尿病生活方式干预研究进展[J]. 中国公共卫生, 2020, 36(10): 1515-1518. doi: 10.11847/zgggws1124000 LI W Q, MI J. Research progress of lifestyle intervention in gestational diabetes[J]. China public health, 2020, 36(10): 1515-1518. doi: 10.11847/zgggws1124000
[4]	NABI T, RAFIQ N, TRIGOTRA S, et al. Clinical characteristics, outcomes, and progression to type 2 diabetes in women with hyperglycemia in pregnancy[J]. Indian J Endocrinol Metab, 2021, 25(6): 538-544. doi: 10.4103/ijem.ijem_440_21
[5]	牛琼华, 肖华蓉. 个性化营养干预在妊娠期糖尿病中的应用效果[J]. 中国食物与营养, 2019, 25(5): 41, 76. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWY201905016.htm NIU Q H, XIAO H. The effect of personalized nutritional intervention in gestational diabetes[J]. China food and nutrition, 2019, 25(5): 41, 76. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWY201905016.htm
[6]	刘乐融, 欧阳冬生, 周栋, 等. 妊娠期糖尿病的医学营养治疗进展[J]. 中国糖尿病杂志, 2017, 25(4): 376-380. doi: 10.3969/j.issn.1006-6187.2017.04.019 LIU L R, OUYANG D S, ZHOU D, et al. Medical nutritional therapy of gestational diabetes[J]. Chinese Journal of diabetes, 2017, 25(4): 376-380. doi: 10.3969/j.issn.1006-6187.2017.04.019
[7]	苏日娜, 杨慧霞. 美国糖尿病学会2019年"妊娠期糖尿病诊治指南"介绍(一)[J]. 中华围产医学杂志, 2019, 22(4): 223-224. doi: 10.3760/cma.j.issn.1007-9408.2019.04.003 SU R N, YANG H X. Introduction to "guidelines for diagnosis and treatment of gestational diabetes" of American Diabetes Association in 2019 (Ⅰ)[J]. Chinese Journal of Perinatal Medicine, 2019, 22(4): 223-224. doi: 10.3760/cma.j.issn.1007-9408.2019.04.003
[8]	高芳凤, 王荣兰, 吴培梨, 等. 海口市妊娠期糖尿病孕妇糖尿病知识知晓状况及其影响因素[J]. 华南预防医学, 2019, 45(5): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201905017.htm GAO F F, WANG R L, WU P L, et al. Awareness of diabetes knowledge among pregnant women with gestational diabetes in Haikou and its influencing factors[J]. South China Preventive Medicine, 2019, 45(5): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF201905017.htm
[9]	梁茜, 张荣. 个体化健康教育方案改善妊娠期糖尿病患者疾病认知和消极情绪的效果分析[J]. 中国妇幼保健, 2020, 35(17): 3141-3144. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202017006.htm LIANG Q, ZHANG R. Analysis of the effect of individualized health education program on improving disease cognition and negative emotions in patients with gestational diabetes[J]. Maternal and Child Health Care of China, 2020, 35(17): 3141-3144. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202017006.htm
[10]	丁绿芬. 健康教育模式在妊娠期糖尿病孕妇孕期管理中的应用效果及对妊娠结局的影响[J]. 中国妇幼保健, 2020, 35(8): 1377-1380. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202008005.htm DING L F. Application effect of health education model in pregnancy management of pregnant women with gestational diabetes and its impact on pregnancy outcome[J]. Maternal and Child Health Care of China, 2020, 35(8): 1377-1380. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202008005.htm
[11]	陈海天, 张少凤, 王子莲. 美国糖尿病学会2019年"妊娠期糖尿病诊治指南"介绍(二)[J]. 中华围产医学杂志, 2019, 22(4): 225-226. CHEN H T, ZAHNG S F, WANG Z L. Introduction to the American Diabetes Association 2019 "guidelines for the diagnosis and treatment of gestational diabetes" (Ⅱ)[J]. Chinese Journal of perinatal medicine, 2019, 22(4): 225-226.
[12]	孟雪莲, 鲍立平, 徐晓艳, 等. 孕前体质指数及妊娠期体重增长与妊娠糖尿病发病率的相关性[J]. 河北医学, 2021, 27(12): 2043-2046. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202112024.htm MENG X L, BAO L P, XU X Y, et al. Correlation between body mass index before pregnancy and weight gain during pregnancy and the incidence rate of gestational diabetes[J]. Hebei Medical Journal, 2021, 27(12): 2043-2046. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202112024.htm
[13]	王丽丽, 田颖, 鲁莉萍. 孕前体重指数与孕期体重增长对孕妇妊娠期糖尿病发病及妊娠结局的影响[J]. 中国妇幼保健, 2019, 34(1): 62-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201901021.htm WANG L L, TIAN Y, LU L P. Effects of pre pregnancy body mass index and weight gain during pregnancy on the incidence and pregnancy outcome of gestational diabetes[J]. Maternal and Child Health Care of China, 2019, 34(1): 62-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201901021.htm
[14]	杜志梅, 倪燕, 江若安, 等. 孕早期医学营养治疗对妊娠期糖尿病患者孕期血糖, 体重, 母儿结局及遵医行为的影响[J]. 中华全科医学, 2021, 19(4): 617-620. doi: 10.16766/j.cnki.issn.1674-4152.001876 DU Z M, NI Y, JIANG R A, et al. Effect of early pregnancy medical nutrition therapy on blood glucose, weight control, maternal and infant outcomes and medical compliance in gestational diabetes mellitus[J]. Chinese Journal of General Practice, 2021, 19(4): 617-620. doi: 10.16766/j.cnki.issn.1674-4152.001876
[15]	仇同同, 邓玉春, 王翠喆, 等. 游离脂肪酸通过FFAR4抑制脂肪细胞KLF15的表达和葡萄糖消耗[J]. 石河子大学学报: 自然科学版, 2020, 38(6): 734-740. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZN202006013.htm QIU T T, DENG Y C, WANG C Z, et al. Free fatty acids inhibit the expression of klf15 and glucose consumption in adipocytes through ffar4[J]. Journal of Shihezi University: Natural Science Edition, 2020, 38(6): 734-740. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZN202006013.htm
[16]	窦攀, 张涵, 杨慧霞. 结合《中国居民膳食营养素参考摄入量(2013版)》和妊娠合并糖尿病相关指南解读妊娠期能量[J]. 中华围产医学杂志, 2015, 18(8): 582-585. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBL201607005.htm DOU P, ZHANG H, YANG H X. Interpreting gestational energy in combination with the reference intake of dietary nutrients for Chinese residents (2013 Edition) and the relevant guidelines for pregnancy with diabetes[J]. Chinese Journal of Perinatal Medicine, 2015, 18(8): 582-585. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBL201607005.htm
[17]	隽娟, 杨慧霞. 美国糖尿病学会"2020年妊娠合并糖尿病诊治指南"介绍[J]. 中华围产医学杂志, 2020, 23(2): 139-141.
[18]	马亭亭, 丁桂凤, 李莉, 等. 低血糖生成指数膳食干预对妊娠期糖尿病孕妇母婴结局的影响[J]. 中国妇幼保健, 2018, 33(11): 2418-2421. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201811007.htm MA T T, DING G F, LI L, et al. Effect of low glycemic index dietary intervention on maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus[J]. Maternal and Child Health Care of China, 2018, 33(11): 2418-2421. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201811007.htm
[19]	VAHEDI L, OSTADRAHIMI A, EDALATI-FARD F, et al. Is fish oil supplementation effective on maternal serum FBS, oral glucose tolerance test, hemoglobin and hematocrit in low risk pregnant women? A triple-blind randomized controlled trial[J]. J Complement Integr Med, 2018, 15(3): 1762-1771.