摘要
目的探讨规范化治疗结合医学营养干预对妊娠期糖尿病(GMD)患者血糖水平、体质量管理及产后3个月糖代谢的影响。方法选取2017年6月至2019年10月北京市顺义区医院收治的114例GMD患者进行研究,采用随机数字表法将患者分为观察组(n=57)和对照组(n=57),对照组采用规范化治疗,观察组采用规范化治疗结合医学营养干预,比较两组患者血糖控制水平、体质量管理、产后3个月糖代谢转归、妊娠结局及新生儿结局。结果治疗后,观察组糖化血红蛋白(HbA1c)[(5.20±0.34)%]、空腹血糖(FPG)[(4.69±0.31)mmol/L]、早餐后2 h血糖水平(2 hPG)[(7.32±2.13)mmol/L]、晚餐后2 hPG[(7.54±2.36)mmol/L]均显著低于对照组[(6.38±0.42)%、(6.34±0.45)mmol/L、(9.01±2.27)mmol/L、(9.35±2.47)mmol/L](t=16.48、22.79、4.09、4.00,均P < 0.001)。观察组孕期体质量增加[(12.19±2.35)kg]、孕期体质量指数(BMI)增加[(4.52±1.13)kg/m2]均显著低于对照组[(16.21±2.64)kg、(6.11±1.25)kg/m2](t=8.58、7.12,均P < 0.001)。观察组产后3个月糖代谢异常率[5.3%(3/57)]略低于对照组[8.8%(5/57)],但差异无统计学意义(χ^(2)=0.53,P=0.462)。观察组的胎膜早破[5.3%(3/57)]、羊水过多[14.0%(8/57)]、剖宫产发生率[15.8%(9/57)]均显著低于对照组[22.8%(13/57)、35.1%(20/57)、40.4%(23/57)](χ^(2)=7.27、6.81、8.51,均P < 0.05),两组妊娠高血压、产后出血发生率差异无统计学意义(P > 0.05)。观察组早产[5.3%(3/57)]、巨大儿[3.5%(2/57)]、呼吸窘迫[7.0%(4/57)]、新生儿低血糖[3.5%(2/57)]、高胆红素血症发生率[5.3%(3/57)]均显著低于对照组[22.8%(13/57)、17.5%(10/57)、21.1%(12/57)、15.8%(9/57)、19.3%(11/57)](χ^(2)=7.27、5.96、5.60、4.93、5.21,均P < 0.05)。结论规范化治疗结合医学营养干预可以对GMD患者的血糖水平有效降低,使体质量得到控制,改善产后3个月糖代谢。
Objective To investigate the effects of standardized treatment combined with medical nutrition intervention on blood glucose level,body mass management and glucose metabolism at 3 months postpartum in patients with gestational diabetes mellitus(GDM).Methods A total of 114 patients with GDM who received treatment in Shunyi District Hospital of Beijing from June 2017 to October 2019 were included in this study.They were randomly divided into observation group(n=57)and control group(n=57).The control group was treated with standardized therapy,and the observation group was treated with standardized therapy combined with medical nutrition intervention.Blood glucose level,body mass management,glucose metabolism outcomes at 3 months postpartum,pregnancy outcome,and neonatal outcome were compared between the two groups.Results After treatment,hemoglobin A1c(HbA1c),fasting blood glucose,2-hour plasma glucose(2hPG)after breakfast,and 2hPG after dinner in the observation group were(5.20±0.34)%,(4.69±0.31)mmol/L,(7.32±2.13)mmol/L,and(7.54±2.36)mmol/L,respectively,which were significantly lower than those in the control group[(6.38±0.42)%,(6.34±0.45)mmol/L,(9.01±2.27)mmol/L,(9.35±2.47)mmol/L,t=16.48,22.79,4.09,4.00,all P<0.001].The increases in body mass and body mass index during pregnancy in the observation groups were(12.19±2.35)kg and(4.52±1.13)kg/m2,respectively,which were significantly lower than those in the control group[(16.21±2.64)kg,(6.11±1.25)kg/m2,t=8.58,7.12,both P<0.001].The abnormal rate of glucose metabolism at 3 months postpartum in the observation group was significantly lower than that in the control group[5.3%(3/57)vs.8.8%(5/57),χ^(2)=0.53,P=0.462].The incidences of premature rupture of membranes,polyhydramnios,and cesarean section in the observation group were 5.3%(3/57),14.0%(8/57)and 15.8%(9/57),which were significantly lower than those in the control group[22.8%(13/57),35.1%(20/57),40.4%(23/57),χ^(2)=7.27,6.81,8.51,all P<0.05].There were no significant differences in the incidences of pregnancy-induced hypertension and postpartum hemorrhage between the two groups(both P>0.05).The incidences of premature births,macrosomia,respiratory distress,neonatal hypoglycemia and hyperbilirubinemia in the observation groups were 5.3%(3/57),3.5%(2/57),7.0%(4/57),3.5%(2/57),5.3%(3/57),respectively,which were significantly lower than those in the control group[22.8%(13/57),17.5%(10/57),21.1%(12/57),15.8%(9/57),19.3%(11/57),χ^(2)=7.27,5.96,5.60,4.93,5.21,all P<0.05).Conclusion Standardized treatment combined with medical nutrition intervention can effectively reduce blood glucose level in patients with GMD,control body mass,and improve glucose metabolism at 3 months after delivery.
作者
贾赛君
万佳义
杜学文
付文君
陈世清
Jia Saijun;Wan Jiayi;Du Xuewen;Fu Wenjun;Chen Shiqing(Department of Endocrinology,Shunyi District Hospital of Beijing,Beijing 101300,China;Department of Obstetrics and Gynecology,Shunyi District Hospital of Beijing,Beijing 101300,China)
出处
《中国基层医药》
CAS
2022年第8期1130-1135,共6页
Chinese Journal of Primary Medicine and Pharmacy
关键词
综合疗法
规范
营养状况
干预性研究
糖尿病
妊娠
血糖
体质量
妊娠结局
婴儿
新生
Combined modality therapy
Benchmarking
Nutritional status
Intervention studies
Diabetes,gestational
Blood sugar
Body quality
Pregnancy outcome
Infant,newborn
