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基于智能手机应用程序对妊娠糖尿病患者饮食干预的研究

Dietary Intervention for Gestational Diabetes Patients Based on Smartphone Application

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【作者】 韩婷婷

【导师】 王晓云

【作者基本信息】 山西医科大学, 护理(专业学位), 2019, 硕士

【摘要】 目的:设计和开发智能手机应用程序“控糖医”,并运用该程序对妊娠糖尿病患者进行饮食干预,通过比较干预前后妊娠糖尿病患者血糖、胰岛素使用情况、体重、自我效能的变化及母婴不良结局的发生率,评价其干预效果。方法:采用便利抽样法选取2018年1月~2018年9月在山西省人民医院内分泌科门诊确诊为妊娠糖尿病的患者156例,并依据随机数字表法分为对照组和干预组,每组各78例。对照组在门诊接受糖尿病健康教育护士的常规指导,干预组在常规指导的基础上采用智能手机应用程序进行饮食干预,对两组患者干预前后的血糖情况、胰岛素使用情况、体重增长、母婴结局和自我效能进行评价。结果:(1)干预前,两组患者的一般资料、血糖值、体重指数和自我效能评分均无统计学差异(P>0.05)。(2)采用重复测量方差分析比较两组妊娠糖尿病患者干预前、干预6周后和干预12周后的血糖差异,结果均具有统计学意义(P<0.05)。不同时点两组妊娠糖尿病患者的空腹、餐后1小时和餐后2小时血糖的比较,差异有统计学意义(F=158.969,F=901.350,F=566.619,P均<0.001),即不考虑组间效应,两组患者的各项血糖值随时间的延长而逐渐降低;时间和组间存在交互效应(F=14.020,F=39.517,F=76.626,P均<0.001),进一步分析单独效应,在固定时间条件下,结果显示干预前两组妊娠糖尿病患者的各项血糖值的比较,差异无统计学意义(P均>0.05);组间效应(F=6.376,F=10.445,F=13.536,P均<0.05),即不考虑时间效应,两组患者各项血糖值的下降幅度有差异。干预12周后,干预组妊娠糖尿病患者干预后的糖化血红蛋白指标优于对照组,差异有统计学意义(P<0.05)。(3)干预组和对照组12周后均有使用胰岛素治疗的患者,两组使用人数无统计学差异(P>0.05),但干预组患者胰岛素全天使用剂量低于对照组,差异有统计学意义(P<0.05)。(4)干预组妊娠糖尿病患者分娩时的体重指数和经干预后的体重增长量均优于对照组,差异有统计学意义(P<0.05)。(5)两组妊娠糖尿病患者除胎膜早破的发生率无统计学差异(P>0.05)外,干预组患者剖宫产、羊水过多、产褥感染以及妊娠期高血压的发生率均低于对照组,差异有统计学意义(P<0.05)。而干预组围产儿不良结局的发生率均低于对照组,差异有统计学意义(P<0.05);(6)干预12周后,干预组妊娠糖尿病患者自我效能得分优于对照组,差异均有统计学意义(P<0.05)。结论:将智能手机应用程序运用于饮食干预中,有利于控制妊娠糖尿病患者的血糖值,降低胰岛素的使用剂量,控制体重增长,减少母婴不良结局的发生率,提高患者的自我效能水平,值得在临床工作中应用与推广。

【Abstract】 Objective :A smartphone application called “Sugar control medicine” was designed and developed,and the procedure was used for dietary intervention in patients with gestational diabetes mellitus.The intervention effect was evaluated by comparing the changes of blood glucose,insulin use,body weight,self-efficacy and the incidence of maternal and child adverse outcomes in patients with gestational diabetes before and after intervention.Methods :A total of 156 patients with gestational diabetes diagnosed in the Department of Endocrinology,Shanxi Provincial People’s Hospital from January to September 2018 were selected by convenient sampling method.According to the random number table method,they were divided into control group and intervention group,78 cases in each group.The control group received routine guidance from the diabetes health education nurses in the outpatient clinic.The intervention group used the smartphone application for diet management based on routine guidance.And evaluated the blood glucose,insulin use,weight gain,maternal and infant outcomes and self-efficacy of the two groups before and after the intervention.Results:(1)Before the intervention,there was no significant difference in general data,blood glucose,body mass index and self-efficacy score between the two groups(P>0.05).(2)The blood glucose difference between the two groups of gestational diabetespatients before intervention,6 weeks after intervention and 12 weeks after intervention was compared by repetitive measure ANOVA.The results were statistically significant(P<0.05).There were significant differences in Fasting blood glucose,One-hour Plasma Glucose and Two-hour Plasma Glucose between the two groups at different time points(F=158.969,F=901.350,F=566.619,P<0.001),that is,regardless of the inter-group effect,the blood glucose levels of the two groups of patients gradually decreased with time;there was an interaction between time and group(F=14.020,F=39.517,F=76.626,P<0.001);And further analysis of individual effects,under fixed time conditions,the results showed that there was no significant difference in blood glucose values between the two groups of gestational diabetes patients before intervention(P>0.05);intergroup effect(F=6.376,F=10.445,F= 13.536,P<0.05),that is,regardless of the time effect,the blood glucose levels of the two groups of patients have different degrees of decline.After 12 weeks of intervention,the glycosylated hemoglobin index of the intervention group was better than that of the control group after intervention(P<0.05).(3)There were no significant differences in the number of patients treated with insulin in the intervention group and the control group after 12 weeks(P>0.05),but the dose of insulin in the intervention group was lower than that in the control group.The difference was statistically significant(P<0.05).(4)The body mass index and the weight gain after intervention in the gestational diabetes patients in the intervention group were superior to the control group,and the difference was statistically significant(P<0.05).(5)There was no significant difference in the incidence of premature rupture of membranes between the two groups of gestational diabetes mellitus(P>0.05).The incidence of cesarean section,polyhydramnios,puerperal infection and gestational hypertension was lower in the intervention group than in the control group.The difference was statistically significant(P<0.05).The incidence of adverse outcomes in perinatal infants in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.05).(6)After 12 weeks of intervention,the self-efficacy score of the intervention group was better than that of the control group,and the differences were statistically significant(P<0.05).Conclusions:Applying the smartphone application to dietary intervention is beneficial to control the blood sugar level,reduce the dose of insulin,control weight gain of gestational diabetes patients,reduce the incidence of maternal and child adverse outcomes,and improve the patient’s self-efficacy level,which is worthy of application and promotion in clinical work.

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