本文選題：妊娠期糖尿病　切入點：個性化　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討妊娠期糖尿病孕婦膳食營養(yǎng)素攝入情況,飲食、運動干預(yù)對妊娠期糖尿病孕婦血糖的預(yù)防效果;對孕期孕婦體重狀況、妊娠結(jié)局的影響。方法:本實驗研究對象均選自于2016年2月~12月在邢臺市人民醫(yī)院產(chǎn)科門診產(chǎn)檢確診為妊娠期糖尿病的24周孕齡的孕婦,共100例。實驗分組方式為隨機抽簽法分為進行飲食、運動個性化指導(dǎo)的干預(yù)組和常規(guī)護理的對照組各50例。研究對象的膳食攝入情況采用食物頻率法進行調(diào)查,分析調(diào)查對象膳食中能量和營養(yǎng)素的攝入情況。干預(yù)組在給予常規(guī)護理的基礎(chǔ)上,結(jié)合各自飲食及運動的不同情況,制定符合個體化的飲食結(jié)構(gòu)和運動方案,給予飲食、運動個性化指導(dǎo),形式包括家庭訪視、門診干預(yù)和電話隨訪。為對照組研究對象講解預(yù)防糖尿病相關(guān)知識,并對其進行一次孕期飲食運動知識宣教。研究對象分別在孕24、28周和分娩前回醫(yī)院測量體重、空腹血糖和餐后2小時血糖。妊娠結(jié)果如剖宮產(chǎn)、新生兒體重、巨大兒、早產(chǎn)、新生兒窒息的資料均來自于病歷。結(jié)果:本實驗共收集干預(yù)組48例和對照組49例全部資料。研究顯示,干預(yù)組和對照組在孕中期每天膳食中的能量和蛋白質(zhì)、脂肪和糖類三大營養(yǎng)物質(zhì),較推薦攝入量相比,能量攝入量偏高,蛋白質(zhì)的攝入量比較低。進行干預(yù)前,干預(yù)組與對照組空腹血糖和餐后2小時血糖差異沒有統(tǒng)計學(xué)意義(P0.05),經(jīng)過對干預(yù)組的營養(yǎng)干預(yù),我們可以發(fā)現(xiàn),干預(yù)組空腹血糖和餐后2小時血糖值均較對照組低,差異具有統(tǒng)計學(xué)意義(P0.05)。干預(yù)組在體重和體重指數(shù)方面,比對照組低,但差異無統(tǒng)計學(xué)意義(P0.05)。進一步將兩組體重及體重指數(shù)增長值進行比較,結(jié)果顯示,干預(yù)組比對照組低,差異有統(tǒng)計學(xué)意義(P0.05)。將兩組剖宮產(chǎn)率展開比較,可以發(fā)現(xiàn)兩組之間的差異沒有統(tǒng)計學(xué)意義(P0.05)。干預(yù)組巨大兒、早產(chǎn)和新生兒窒息發(fā)生率都低于對照組,且有顯著性差異(P0.05)。干預(yù)組與對照組相比,在新生兒體重方面無顯著性差異(P0.05)。結(jié)論:1妊娠期糖尿病患者在孕中期膳食中能量攝入量偏高,蛋白質(zhì)攝入偏低,三大營養(yǎng)素產(chǎn)能比不合理。2孕期飲食運動指導(dǎo)能有效控制孕婦的體重及體重指數(shù)的增長。3飲食、運動個性化指導(dǎo)顯著改善妊娠期糖尿病血糖水平。4對巨大兒、早產(chǎn)和新生兒窒息的發(fā)生率起到降低作用;但是,在干預(yù)剖宮產(chǎn)率和新生兒體重方面,還需要進一步探究。
[Abstract]:Objective: to investigate the effect of dietary nutrition intake, diet and exercise intervention on blood glucose of pregnant women with gestational diabetes mellitus, and to evaluate the body weight status of pregnant women with gestational diabetes mellitus. Methods: all the subjects were selected from 24 weeks pregnant women who were diagnosed as gestational diabetes mellitus (GDM) in outpatient department of obstetrics and obstetrics of Xingtai people's Hospital from February to December 2016. A total of 100 patients were divided into diet, exercise individualized instruction intervention group and routine nursing control group by random drawing of lots. The dietary intake of the subjects was investigated by the method of food frequency. The intake of energy and nutrients in the diet of the subjects was analyzed. On the basis of routine nursing care, the intervention group made the diet structure and exercise plan according to the different conditions of their diet and exercise, and gave them diet. Exercise individualized instruction, in the form of family visit, outpatient intervention and telephone follow-up. The subjects measured their body weight, fasting blood glucose and 2 hours postprandial blood glucose at 2428 weeks of pregnancy and before delivery. The results of pregnancy such as cesarean section, newborn weight, macrosomia, premature delivery, Results: the data of 48 cases in the intervention group and 49 cases in the control group were collected. The study showed that the energy and protein in the daily diet of the intervention group and the control group in the second trimester of pregnancy. Compared with the recommended intake, the three nutrients of fat and sugar are higher in energy intake and lower in protein intake. There was no significant difference in fasting blood glucose and 2 hours postprandial blood glucose between the intervention group and the control group (P 0.05). After nutritional intervention in the intervention group, we could find that the fasting blood glucose and 2 hours postprandial blood glucose in the intervention group were lower than those in the control group. The difference was statistically significant (P 0.05). The body mass index (BMI) of the intervention group was lower than that of the control group, but there was no significant difference between the two groups. Further comparison was made between the two groups. The results showed that the intervention group was lower than the control group. The difference was statistically significant (P 0.05). By comparing the cesarean section rate between the two groups, it was found that there was no significant difference between the two groups. The incidence of macrosomia, premature delivery and neonatal asphyxia in the intervention group was lower than that in the control group. There was no significant difference in neonatal body weight between the intervention group and the control group (P 0.05). Conclusion the dietary energy intake and protein intake of gestational diabetes mellitus patients with gestational diabetes mellitus during the second trimester of pregnancy were higher and protein intake was lower in the intervention group than in the control group. The three main nutrients production capacity ratio is unreasonable. 2. Exercise guidance during pregnancy can effectively control the increase of body mass and body mass index of pregnant women, and exercise individualized instruction can significantly improve the blood glucose level of gestational diabetes mellitus (GDM) and improve the macrosomia of gestational diabetes mellitus (GDM). The incidence of premature birth and neonatal asphyxia has been reduced; however, further research is needed in terms of intervention in cesarean section and neonatal weight.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256

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