Application of perinatal nutrition-metabolism combined evidence-based nursing model in patients with gestational diabetes mellitus
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摘要:
目的 妊娠期糖尿病可导致母婴不良结局，单一护理模式对妊娠结局的改善效果有限。本研究旨在构建并验证基于循证护理的营养-代谢护理模式在围产期糖尿病患者中的应用效果。 方法 选取2024年2月—2025年1月舟山市妇女儿童医院收治的妊娠28~35周孕妇，诊断为妊娠期糖尿病的围产期患者100例为研究对象。使用随机数表法将患者分为对照组(50例)和研究组(50例)，对照组接受常规护理，研究组在对照组的基础上实施围产期营养-代谢联合循证护理模式。比较2组患者的血脂水平、血糖水平，孕期体重增长情况、自然分娩率、住院时间、产后72 h纯母乳喂养率，妊娠期及产后合并症、并发症发生率，新生儿不良结局发生率。 结果 干预后，研究组患者的HDL、LDL、TG、TC水平均显著低于对照组(P＜0.05)，且数值在正常范围内；研究组患者的FBG和2hPG均显著低于对照组(P＜0.05)；研究组患者的体重增长低于对照组(P＜0.05)。研究组患者的自然分娩率和产后72 h纯母乳喂养率分别为76.0%(38/50)和92.0%(46/50)，均优于对照组[58.0%(29/50)和76.0%(38/50)，P＜0.05]。研究组患者住院时间短于对照组[(6.22±1.68)d vs. (7.02±2.17)d，P＜0.05)]；研究组患者的不良妊娠结局发生率和新生儿不良结局发生率均低于对照组(P＜0.05)。 结论 围产期营养-代谢联合循证护理模式能够改善围产期糖尿病患者的血脂和血糖水平，控制体重增长，降低不良妊娠结局发生率。 Abstract:Objective Gestational diabetes mellitus (GDM) has been associated with adverse maternal and infant outcomes, and the single nursing model has been demonstrated to have a limited effect on improving pregnancy outcomes. The objective of this study is to develop and validate the application of the nutrition and metabolism nursing model, grounded in evidence-based nursing principles, for patients diagnosed with perinatal diabetes mellitus. Methods A total of 100 perinatal patients diagnosed with gestational diabetes mellitus at 28-35 weeks of gestation and admitted to Zhoushan Women and Children's Hospital from February 2024 to January 2025 were selected as the research subjects. The patients were divided into control group (n=50) and study group (n=50) by random number table method. The control group received routine nursing care, while the study group received perinatal nutrition-metabolism combined evidence-based nursing care, based on the findings of the control group. The investigation focused on a comprehensive set of health metrics, including blood lipid levels, blood glucose levels, weight gain during pregnancy, natural delivery rate, length of hospital stay and exclusive breastfeeding rate within 72 hours after delivery. A comparative analysis was conducted between the two groups, with the objective of identifying potential disparities in health outcomes. The present study will examine the incidence of complications during pregnancy and postpartum, as well as the incidence of adverse neonatal outcomes. Results Subsequent to the intervention, the levels of HDL, LDL, TG and TC in the study group were found to be significantly lower than those in the control group (P < 0.05), and the values were within the normal range. The FBG and 2hPG of levels of the study group were found to be significantly lower than those of the control group (P < 0.05). The weight gain of the study group was lower than that of the control group (P < 0.05). The natural delivery rate and exclusive breastfeeding rate within 72 hours postpartum in the study group were 76.0% (38/50) and 92.0% (46/50), respectively, which were superior to those in the control group [58.0% (29/50) and 76.0% (38/50), P < 0.05]. The length of hospital stay in the study group was found to be shorter than that in the control group [(6.22±1.68) d vs. (7.02±2.17) d, P < 0.05]. The incidence of adverse pregnancy outcomes and adverse neonatal outcomes in the study group was lower than that in the control group (P < 0.05). Conclusion The perinatal nutrition-metabolism combined evidence-based nursing model has been demonstrated to improve the blood lipid and blood glucose levels in patients with perinatal diabetes mellitus, control the weight gain, and reduce the incidence of adverse pregnancy outcomes. -
表 1 2组妊娠期糖尿病患者血脂指标水平比较(x±s, mmol/L)
Table 1. Comparison of lipid profile levels between the two groups of patients with gestational diabetes mellitus (x±s, mmol/L)
组别 例数 HDL LDL TG TC 对照组 50 2.01±0.31 3.89±0.63 3.61±1.55 7.15±1.10 研究组 50 1.85±0.35 3.42±0.77 3.02±1.17 6.14±1.31 t值 2.419 3.341 2.148 4.175 P值 0.017 0.001 0.034 ＜0.001 
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表 2 2组妊娠期糖尿病患者糖代谢水平比较(x±s, mmol/L)
Table 2. Comparison of glycemic control between the two groups of patients with gestational diabetes mellitus (x±s, mmol/L)
组别 例数 FBG 2hPG 干预前 干预后 干预前 干预后 对照组 50 5.68±0.59 5.36±0.78 8.62±1.36 6.05±1.13 研究组 50 5.62±0.67 4.41±0.42 8.44±1.23 5.59±1.14 统计量 0.538a 8.231b 0.699a 8.542b P值 0.629 0.021 0.612 0.016 注：a为t值，b为F值。
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表 3 2组妊娠期糖尿病患者恢复情况比较
Table 3. Comparison of glycemic control status between the two groups of patients with gestational diabetes mellitus
组别 例数 孕期体重增长情况(x±s，kg) 自然分娩[例(%)] 住院时间(x±s，d) 产后72 h纯母乳喂养[例(%)] 对照组 50 10.65±3.69 29(58.0) 7.02±2.17 38(76.0) 研究组 50 9.26±3.08 38(76.0) 6.22±1.68 46(92.0) 统计量 2.045a 7.636b 2.061a 4.714b P值 0.043 0.005 0.042 0.030 注：a为t值，b为χ2值。
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