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学科主题: 护理学
题名:
妊娠期糖尿病一日营养门诊实践效果分析
作者: 王巧红
答辩日期: 2014-11-20
导师: 陆虹
专业: 护理学
授予单位: 北京大学
授予地点: 北京大学护理学院
学位: 硕士
关键词: 妊娠期糖尿病 ; 一日营养门诊 ; 医学营养治疗 ; 实践模式
其他题名: The analysis of the effects of “one-day Nutrition Clinic for GDM” practice
分类号: R473.71
摘要:

目的:分析GDM一日营养门诊干预模式的实践效果,探讨GDM一日营养门诊新模式及临床实践中的问题,为临床实践和探索GDM医学营养治疗实践模式提供参考依据。

方法:采用类实验性研究方法,方便抽样选取20136月至201310月在北京某三甲综合医院产科建档规律产检、确诊为GDM并于此院分娩的88例孕妇为历史对照组, 20146月至201410月在该产科建档规律产检、确诊为GDM并于此院分娩的51例孕妇为实验组。对实验组进行GDM一日营养门诊干预,与接受常规产检医生的口头营养指导的历史对照组进行妊娠结局比较,对数据采用spss 16.0进行分析。另外,采用访谈法,了解实验组孕妇及产科门诊医生对GDM一日营养门诊的接受度和存在的问题,对访谈资料进行类属分析,归纳、提炼主题。

结果:

1. 接受GDM一日营养门诊干预的孕妇,与接受常规医生口头营养指导的历史对照组相比,妊娠期贫血发生率下降,差异有统计学意义(P0.05),妊娠期蛋白尿、胎膜早破、羊水过多/过少、产后出血的发生率无统计学差异(P0.05);与对照组相比,实验组妊娠晚期空腹血糖和餐后2h血糖控制满意率较高,差异有统计学意义(P0.01),胰岛素使用率和尿酮体阳性率两组间无差异(P0.05);GDM一日营养门诊组孕期住院次数明显少于常规治疗组(P0.01)。

2. GDM一日营养门诊干预降低了新生儿儿科转诊率,两组间比较差异有统计学意义(P0.05);两组间新生儿出生身长、体重及新生儿Apgar评分比较差异无统计学意义(P0.05

3. 两组间孕期总增重比较无明显差异(P0.05),不同孕前BMI两组间孕期增重比较结果显示:孕前BMI18.5时,实验组孕期增重多于对照组孕妇,差异有统计学意义(P0.05)。

4. 应用类属分析法依据访谈资料提炼出6个主题:GDM一日营养门诊患者接受度和满意度高;患者对GDM的认知程度、依从性提高,饮食观念和生活方式改善;家属一起参与效果好;完全遵循饮食建议有一定困难,近足月时饮食控制有放松趋势;追访需整合多种途径;有助于GDM患者的统一管理,减少了GDM英文摘要:

Objective: To analyze the effects of “one-day Nutrition Clinic for GDM” practice, discuss the issues found in the new practical pattern and clinical practice, provide evidences to the Medical Nutritional Treatment of GDM as a clinical route model.

Methods: A quasi-experiment study method was applied, using convenience samplinghistorical control group and intervention group were set up. All objects followed regular prenatal examination, recorded in the files, diagnosed as GDM and labor in the certain hospital. 88 gravida were selected in historical control group, and 51 in intervention group. Control group adopted normal oral nutritional instruction from prenatal doctors , while Intervention group adopted one-day clinic intervention except conventional oral instruction . Data of gestational ending were analyzed using spss 16.0. In addition, interview were conducted, to get the acceptability and existing problems feedback, from intervention group gravida and doctors. Generic analysis including Induction and theme refining were used to analyze the data.

Results:

1. The incidence of Anemia during pregnancy in the intervention group was lower, than the historical control group(P0.05); There were no statistical significant differences between the two groups of the incidence of gestational proteinuria, premature rupture of membrane polyhydramniosoligohydramnios and postpartum hemorrhage(P0.05); Compared with control group, the intervention group in late pregnancy fasting blood glucose and postprandial 2h blood glucose control satisfaction rate is higher, the difference was statistically significant (P < 0.01), There were no differences of sinsulin utilization rate and the positive rate of urine ketone body between the two groups (P > 0.05); GDM day nutrition during pregnancy in the hospital outpatient service group significantly less than the conventional treatment group (P < 0.01); Admission during pregnancy was decreased in the intervention group (P < 0.01).

2. After the one-day Nutrition Clinic for GDM, the neonatal pediatric referral rate decreased (P < 0.05); There were no statistical differences between the two groups of Neonate on the birth body length, body weight and neonatal Apgar score (P > 0.05).

3. There was no significant difference of gestational weight gain between the intervention group and the control group (P > 0.05); But when pre-pregnant BMI < 18.5, the gestational weight gain of GDM gravida in the intervention group was higher than the control group (P < 0.05).

4. Six themes were induced through depth interview by using categorization: The acceptance and satisfaction of the patients on the one-day Nutrition Clinic for GDM was high; Patients' cognition of GDM and diet, aherence to diet advice and the life-style were improved; The effect of participating of family membersn was  approved; It is difficult to completely follow the dietary advice, and there were downward trends in adherence to diet advice close to full term; Integrating a variety of approaches to realize follow-up; The implementation of one-day Nutrition Clinic was conducive to the unified management of GDM patients, in addition, it reduced the GDM related admission.

Conclusion: The accept degree of one-day Nutrition Clinic practice mode was high, which could improve the nutritional therapy compliance of patients, and was conducive to the improvement of pregnancy outcomes .. In addition, it saved medical costs. But in the actual diet management, more concern should be paid on the individualized guidance and supervision of the patients eating out and together with families. The results and experience of the study was wanted to be used to improve clinical practical patter of Medical Nutritional Treatment of GDM.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/108196
Appears in Collections:北京大学护理学院_学位论文

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作者单位: 北京大学护理学院

Recommended Citation:
王巧红. 妊娠期糖尿病一日营养门诊实践效果分析[D]. 北京大学护理学院. 北京大学. 2014.
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