妊娠期糖尿病产妇新生儿住院期间血糖管理最佳证据及其临床实践  

Best evidence and clinical practice of glycemic management in newborns with gestational diabetes mellitus during hospitalization

作　　者：龚加美 耿力 马芳 钟庆华 白阳娟 侯晓梅 李燕 GONG Jiamei;GENG Li;MA Fang;ZHONG Qinghua;BAI Yangjuan;HOU Xiaomei;LI Yan(School of Nursing,Kunming Medical University,Yunnan 650500 China;The First Affiliated Hospital of Kunming Medical University)

机构地区：[1]昆明医科大学护理学院,云南650500 [2]昆明医科大学第一附属医院

出　　处：《循证护理》2025年第8期1492-1500,共9页Chinese Evidence-Based Nursing

基　　金：云南省卫生健康委员会医学后备人才培养计划,编号:H-2019079;昆明医科大学第一附属医院院内护理科研基金项目,编号:2023HL01Z。

摘　　要：目的:对妊娠期糖尿病(GDM)产妇的新生儿血糖管理相关研究进行最佳证据总结,并进行临床实践,验证其临床应用效果。方法:系统检索GDM产妇新生儿住院期间血糖管理的相关文献,并对文献进行质量评价和证据汇总,针对GDM产妇新生儿血糖管理形成的预防、监测、护理等共14条最佳证据,并根据FAME原则[可行性(feasibility)、适宜性(appropriateness)、临床意义(meaningfulness)和有效性(effectiveness)]生成14条审查指标,进行基线审查,分析障碍因素后制定护理对策。于2022年12月—2023年12月选取昆明医科大学第一附属医院产科护士和在此期间住院的GDM产妇新生儿为审查对象进行临床实践,观察证据应用前后护士对审查指标的依从率及知识得分,以及GDM产妇新生儿低血糖发生率及转诊率。结果:证据应用后,护士对新生儿血糖管理的认知有所提高,差异有统计学意义(P<0.05);审查指标依从率中,保暖和喂养、评估和识别高危因素、正确识别低血糖临床表现、发现饥饿信号、饥饿时的喂养频次、母乳喂养时间、补充制剂的依从率比较,证据应用前后差异有统计学意义(P<0.05);且新生儿转诊率下降(P<0.05)。结论:本研究基于循证方法形成的规范化管理流程可以使护士的专业技能得到提高,保障新生儿发生低血糖后的处置有效性,经过管理后儿科转诊率降低,形成了“医生-护士-产科-儿科”联合的一体化病人管理闭环流程,护理常规及操作技能得到了优化。Objective:To summarize the best evidence from studies related to the management of neonatal glucose in women with gestational diabetes mellitus(GDM),and to validate its clinical application in clinical practice.Methods:A systematic search of relevant literature on glycemic management during hospitalization of maternal neonates with GDM was conducted,and the literature was evaluated for quality and evidence summarized to form a total of 14 best evidence for prevention,monitoring,and care for glycemic management of maternal neonates with GDM.A total of 14 pieces of best evidence for prevention,monitoring,and care of maternal glucose management in GDM newborns were developed based on the FAME principle,14 review indicators were generated,a baseline review was conducted,and care responses were developed after analyzing barriers.Nurses in the obstetrics department of the First Affiliated Hospital of Kunming Medical University and GDM maternal neonates hospitalized during this period were selected for the review in December 2022—2023 for clinical practice,and the adherence rates and knowledge scores of nurses to the review indicators,as well as the incidence of hypoglycemia and referral rates of GDM maternal neonates before and after the application of the evidence were observed.Results:After the application of the evidence,the nurses'knowledge of neonatal glucose management improved,and the difference was statistically significant(P<0.05);among the compliance rates of the reviewed indicators,the comparison of the compliance rates of warmth and feeding,assessing and identifying high-risk factors,correctly identifying the clinical manifestations of hypoglycemia,detecting hunger signals,the frequency of feeding in the event of hunger,the duration of breastfeeding,and supplemental preparations,the difference before and after evidence application was statistically significant(P<0.05);and the neonatal referral rate decreased(P<0.05).Conclusion:The standardized management process based on the evidence-based methodology of

关 键 词：新生儿低血糖 血糖管理 妊娠期糖尿病 最佳证据 循证护理 临床实践 

分 类 号：R473.71[医药卫生—护理学]