妊娠期糖尿病患者围术期基于ERAS理念的多学科合作护理方案构建与应用  

Construction and application of a multidisciplinary cooperative nursing plan based on ERAS concept in perioperative period of gestational diabetes patients

作　　者：李华[1] 赵明霞[2] 徐姗[1] Li Hua;Zhao Mingxia;Xu Shan(Department of Obstetrics,Jinan Central Hospital,Jinan 250013,China;Department of Pediatrics,Jinan Central Hospital,Jinan 250013,China)

机构地区：[1]济南市中心医院产科,250013 [2]济南市中心医院儿科,250013

出　　处：《国际医药卫生导报》2021年第17期2694-2699,共6页International Medicine and Health Guidance News

基　　金：2020年度济南市卫生健康委员会第二批科技计划项目(2020-4-28)。

摘　　要：目的探究妊娠期糖尿病患者围术期基于加速康复外科(ERAS)理念的多学科合作护理方案的临床应用效果。方法成立妊娠期糖尿病围术期护理小组,通过病例回顾,采用多因素logistic回归分析妊娠期糖尿病患者剖宫产后不良妊娠结局的影响因素,根据多因素logistic回归分析结果构建妊娠期糖尿病患者围术期基于ERAS理念的多学科合作护理方案。选取济南市中心医院2018年9月至2020年10月住院剖宫产分娩的妊娠期糖尿病患者200例,采用随机数字表法分为对照组与观察组。对照组产妇100例,年龄(27.94±2.21)岁,实施常规剖宫产围术期护理;观察组产妇100例,年龄(28.25±2.11)岁,在对照组的基础上实施妊娠期糖尿病患者围术期基于ERAS理念的多学科合作护理方案。比较两组产妇围术期指标(术中出血量、肛门排气时间、围术期血糖、首次下床活动时间、产妇低血糖、围术期感染)及新生儿指标(新生儿低血糖、新生儿窒息)。结果多因素logistic回归分析显示,SDS评分、生殖道炎症、预防性应用抗生素、术前禁食时间、术前禁饮时间、术后果糖注射液补液、实时动态血糖监测等均是妊娠期糖尿病剖宫产后不良妊娠结局的围术期独立危险因素(均P<0.05)。根据围术期独立危险因素构建护理方案,应用结果显示,观察组产妇术中出血量(289.34±93.28)ml、产妇低血糖(4.00%,4/100)、围术期感染(3.00%,3/100)均少于对照组(t=3.777、χ^(2)=4.348、χ^(2)=8.791,均P<0.05);观察组产妇术中血糖为(5.41±0.57)mmol/L、术后随机血糖为(5.69±0.48)mmol/L,对照组分别为(6.73±0.81)mmol/L、(6.61±0.26)mmol/L,两组比较差异均有统计学意义(t=13.327、16.853,均P<0.05);观察组产妇肛门排气时间为(18.28±1.27)h、首次下床活动时间为(6.23±3.72)h,对照组分别为(22.38±2.10)h、(29.48±8.74)h,两组比较差异均有统计学意义(t=16.706、24.477,均P<0.05);观察组新生儿低Objective To explore the clinical application effect of multidisciplinary cooperative nursing plan based on enhanced recovery after surgery(ERAS)concept in the perioperative period of patients with gestational diabetes mellitus.Methods A perioperative nursing team for gestational diabetes was established.Through case retrospective analysis,multivariate logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in the patients with gestational diabetes after cesarean section.According to the results of multivariate logistic regression analysis,a multidisciplinary cooperative nursing plan based on the concept of ERAS in the perioperative period of the gestational diabetes patients was constructed.Two hundred gestational diabetes patients who took cesarean section in Jinan Central Hospital from September 2018 to October 2020 were selected and divided into a control group and an observation group by the random number table method,with 100 cases in each group.The control group were(27.94±2.21)years old,and received routine perioperative care for the cesarean section.The observation group were(28.25±2.11)years old,and implemented the perioperative multidisciplinary cooperative nursing plan for gestational diabetes based on the ERAS concept on the basis of the control group.The perioperative indicators,including intraoperative blood loss,anal exhaust time,perioperative blood glucose,time to get out of bed for the first time,maternal hypoglycemia,and perioperative infection,and neonatal indicators,including neonatal hypoglycemia and neonatal asphyxia,were compared between these two groups.Results Multivariate logistic regression analysis showed that SDS score,genital tract inflammation,preventive antibiotics,preoperative fasting time,preoperative liquid fasting time,postoperative fructose injection rehydration,and real-time dynamic blood glucose monitoring were all perioperative independent risk factors for adverse pregnancy outcomes after cesarean section for the patients with gestat

关 键 词：妊娠期糖尿病 围术期 ERAS理念 多学科合作 护理方案 

分 类 号：R473.71[医药卫生—护理学]