妊娠期糖尿病管理模式及对母婴结局影响.docVIP

妊娠期糖尿病管理模式及对母婴结局影响 　　[摘要] 目的 探讨妊娠期糖尿病的孕期管理模式及其对孕妇和围生儿的影响,为妊娠期糖尿病的干预提供科学依据。方法 选择确诊的妊娠期糖尿病患者120例,其中75例作为干预研究组由专人进行饮食和锻炼指导,必要时应用胰岛素治疗,并进行母胎监护和产科干预;另外45例为干预对照组在孕期未采用综合的孕期管理干预;选取同期在该医院住院分娩的血糖正常100例孕妇作为正常对照组;比较三组产妇的母婴结局。结果 干预研究组的妊娠期高血压疾病、胎膜早破、早产、胎儿窘迫的发生率与正常对照组相比差别无统计学意义(P0.05),但是巨大儿、剖宫产的发生率高于正常对照组(P 　　[关键词] 妊娠期糖尿病;干预;妊娠结局 　　[中图分类号] R714.256[文献标识码] A[文章编号] 1673-9701(2010)10-86-02 　　 　　Management Mode of Gestational Diabetes Mellitus and Pregnant Outcome of Mothers and Babies 　　LUO Xiaoqin 　　Shiyan People’s Hospital,Baoan District,Shenzhen 518048,China 　　 　　[Abstract] Objective To explore the management mode of gestational diabetes mellitus (GDM)and pregnant outcome of mothers and babies,and to supply the basis for shaping the intervention strategy. Methods 120 cases with GDM were selected,among of them 75 pregnant women (intervention group)were given diet and exercise guidance in person,insulin injection were given when necessary and the mothers and fetuses were monitored and were given obstetric intervention,the other pregnant women who received routine examination were taken as interventional control. A total of 100 normal pregnant women at the same time and same hospital were taken as normal control. Results The incidence of hypertension,premature rupture of membranes,premature delivery and fetal distress in intervention group have no difference significantly with that in normal control group(P0.05),but the rate of macrosomia and cesarean section in intervention group were higher significantly than that in normal control group(P0.05),见表1。 　　1.2诊断方法与诊断标准 　　口服葡萄糖50g行糖筛查,如1h血糖≥7.8mmol/L为阳性,再行口服糖耐量试验(OGTT),空腹及服糖后1h、2h、3h的4次血糖最大正常值分别为5.6mmol/L、10.3mmol/L、8.6mmol/L、6.7mmol/L,有2或2项以上达到或超过正常值或2次空腹血糖≥5.8mmol/L诊断为GDM[3]。 　　1.3孕期管理模式 　　正常对照组和干预对照组仅在普通门诊接受常规检查,而干预研究组由专人负责。 　　1.3.1饮食指导按孕妇标准体重计算每日所需的总热量,每日按(125.5～146.4)kJ/kg供给热量,使每周体重增加量在理想范围之内。产后饮食指导可根据标准体重结合工作强度,使其体重控制在(1±5%)标准体重,标准体重(kg)=身高(cm)-105。合理分配三大营养素以及维生素、微量元素和膳食纤维的摄取。 　　1.3.2锻炼测定产前采用臂部测力计进行运动,每周3次,每次20min。