三种食物交换份法对妊娠期糖尿病患者的干预效果比较

发布时间：2018-11-18 21:10

【摘要】：目的探讨基于血糖负荷概念的食物交换份法、基于血糖生成指数的食物交换份法与传统食物交换份法在妊娠期糖尿病(GDM)患者营养干预中的应用效果,为临床选择合适的营养干预方法提供参考。方法将113例妊娠28周前GDM患者采用随机数字表法均分为3组:研究A组,38例,采用基于血糖生成指数的食物交换份法行营养干预;研究B组,43例,采用基于血糖负荷概念的食物交换份法行营养干预;对照组,32例,采用传统食物交换份法行营养干预,三组间一般情况差异无统计学意义(P0.05)。由专人(经过培训)按照各个干预方案要求统一进行干预,利用每周门诊随访、讲座培训、现场示范与指导、网络QQ群等形式加强干预效果并确保质量控制效果,干预直至妊娠结束。干预前与分娩前分别监测空腹血糖、餐后1及2 h血糖、糖化血红蛋白、三酰甘油、胆固醇等指标,分娩时记录巨大儿发生率、胎儿宫内窘迫情况、新生儿低血糖发生率、剖宫产率。结果干预过程中研究A组有5例脱落,研究B组有10例脱落,对照组有1例脱落,但不影响统计学分析。干预后三组患者餐后1及2 h血糖、糖化血红蛋白、三酰甘油、胆固醇检查结果变化显著优于干预前,研究B组显著优于另外两组,差异有统计学意义(P0.05)。对照组巨大儿发生率、胎儿宫内窘迫情况、新生儿低血糖发生率、剖宫产率均较另外两组高,研究B组较研究A组更好,差异有统计学意义(P0.05)。结论结合血糖生成指数或血糖负荷概念的改良食物交换份法更有助于改善GDM患者的糖、脂代谢状况,并能够较好地改善妊娠结局;其中较为先进的血糖负荷概念的改良食物交换份法效果更好。但由于部分食物血糖生成指数和绝大部分食物血糖负荷指数缺乏,且操作方法又有一定的复杂性,会影响这些新方法的推广应用,也会降低患者的接受程度。因此,还需要进一步加强研究完善。
[Abstract]:Objective to explore the effect of food exchange method based on the concept of blood glucose load, the method of food exchange based on glycemic index and the traditional method of food exchange on nutritional intervention in (GDM) patients with gestational diabetes mellitus (GDM). To provide a reference for clinical selection of appropriate nutritional intervention methods. Methods 113 patients with GDM before 28 weeks of gestation were randomly divided into 3 groups: group A, 38 patients were treated with food exchange method based on glycemic index. In group B, 43 cases were treated with food exchange method based on the concept of blood glucose load, while 32 cases in control group were treated with traditional food exchange method. There was no significant difference in general situation among the three groups (P0.05). In accordance with the requirements of each intervention program, special personnel (after training) make use of weekly out-patient follow-up, lecture training, on-site demonstration and guidance, network QQgroup and other forms to strengthen the intervention effect and ensure the effect of quality control. Intervention until the end of pregnancy. Fasting blood glucose, 1 and 2 h postprandial blood glucose, glycosylated hemoglobin, triglyceride and cholesterol were monitored before and before delivery. The incidence of macrosomia, fetal distress and neonatal hypoglycemia were recorded. Cesarean section rate Results in the course of intervention, there were 5 cases of abscission in group A, 10 cases in group B and 1 case in control group, but it had no effect on statistical analysis. The changes of blood glucose, glycosylated hemoglobin, triglyceride and cholesterol in three groups were significantly better than those before intervention, and that in group B was significantly better than that in the other two groups (P0.05). The incidence of macrosomia, fetal distress, neonatal hypoglycemia, cesarean section rate in the control group were higher than the other two groups, the study group B was better than the study group A, the difference was statistically significant (P0.05). Conclusion the improved food exchange method combined with the concept of blood glucose production index or blood glucose load can improve the glucose and lipid metabolism of GDM patients and improve the pregnancy outcome. One of the more advanced concept of blood sugar load improved food exchange method is more effective. However, due to the lack of some food glucose production index and most of the food glucose load index, and the complexity of the operation methods, the popularization and application of these new methods will be affected, and the acceptance degree of patients will also be reduced. Therefore, it is necessary to further strengthen the research and perfection.
【作者单位】：江苏省南通市妇幼保健院内科;江苏省无锡市第三人民医院妇产科;
【基金】：江苏省营养学会营养与健康研究资助项目(编号:JYX201303) 江苏省无锡市卫生局适宜卫生技术推广项目(编号:T201308)
【分类号】：R714.256

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