1例2型糖尿病多发微血管病变患者的围产期护理

doi:10.3761/j.issn.0254-1769.2022.10.014

摘要/Abstract

摘要：

总结1例2型糖尿病多发微血管病变患者的围产期护理。护理要点包括：组织多学科联合会诊,制订个体化治疗方案;做好患者与胎儿的安全管理;早期评估与识别病情变化,适时终止妊娠;积极预防和处理产后并发症;实施母婴分离下的母乳喂养;给予针对性的心理护理及院外延续性随访护理。经过多学科团队的综合管理,母婴病情稳定出院。随访6个月,母婴状况良好。

关键词: 糖尿病, 微血管病变, 妊娠, 围产期护理

Abstract:

To summarize the perinatal care of a case of type 2 diabetes mellitus with multiple microangiopathy. Key points of care include：organizing joint multidisciplinary consultations and developing individualized treatment plans;managing the safety of patients and fetuses well;early assessment and identification of disease changes,timely termination of pregnancy;active preventing and managing postpartum complications;implementation of breastfeeding under mother-infant separation;giving targeted psychological care and continuous out-of-hospital follow-up care. After the comprehensive management of a multidisciplinary team,the mother and her child were discharged from the hospital in a stable condition. The mother and child were in good condition after 6 months follow-up.

Key words: Diabetes Mellitus, Microangiopathy, Pregnancy, Perinatal Care

张乐, 金颖, 刘宁宁, 冯素文. 1例2型糖尿病多发微血管病变患者的围产期护理[J]. 中华护理杂志, 2022, 57(10): 1242-1246.

ZHANG Le, JIN Ying, LIU Ningning, FENG Suwen. Perinatal care of a case of type 2 diabetes mellitus with multiple microangiopathy[J]. Chinese Journal of Nursing, 2022, 57(10): 1242-1246.

参考文献 14

[1]	王吉耀. 内科学[M]. 2版北京: 人民卫生出版社, 2010:1038-1040.
	Wang JY. Internal medicine[M]. 2nd ed. Beijing: People’s Med-ical Publishing House, 2010:1038-1040.
[2]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014)[J]. 中华妇产科杂志, 2014, 49(8):561-569.
	Obstetrics and Gynecology Branch of Chinese Medical Association, Pregnancy and Diabetes Association of Chinese Medical Association Perinatal Medicine Branch. Guidelines for diagnosis and treatment of gestational diabetes mellitus(2014)[J]. J Clin Gynecol, 2014, 49(8):561-569.
[3]	Fitzpatrick A, Mohammadi F, Jesudason S. Managing pregnancy in chronic kidney disease:improving outcomes for mother and baby[J]. Int J Womens Health, 2016, 8:273-285. DOI PMID
[4]	Haseler E, Melhem N, Sinha MD. Renal disease in pregnancy:fetal,neonatal and long-term outcomes[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 57:60-76. DOI PMID
[5]	王昊, 漆洪波. 2019 ADA“妊娠合并糖尿病管理”指南要点解读[J]. 中国实用妇科与产科杂志, 2019, 35(8):890-894. DOI
	Wang H, Qi HB. Interpretation of the main points of ADA guidelines for the management of pregnancy complicated with diabetes(2019)[J]. Chin J Pract Gynecol Obstet, 2019, 35(8):890-894.
[6]	Chinese Diabetes Society. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018, 38(4):292-344.
	Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China(2017 edition)[J]. Chin J Pract Intern Med, 2018, 38(4):292-344.
[7]	倪叶彬, 陈亚梅, 朱晓萍, 等. 糖尿病患者围手术期血糖管理的证据总结[J]. 中华护理杂志, 2021, 56(7):1079-1085.
	Ni YB, Chen YM, Zhu XP, et al. Evidence summary for management of perioperative blood glucose in patients with diabetes mellitus[J]. Chin J Nurs, 2021, 56(7):1079-1085.
[8]	Ornoy A, Becker M, Weinstein-Fudim L, et al. Diabetes during pregnancy:a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. A clinical review[J]. Int J Mol Sci, 2021, 22(6):2965. DOI URL
[9]	冯烨, 杨慧霞. 产后出血的早期识别和标准管理流程[J]. 中国临床医生杂志, 2019, 47(11):1264-1268.
	Feng Y, Yang HX. Early identification and standard management procedures for postpartum bleeding[J]. Chin J Clin, 2019, 47(11):1264-1268.
[10]	卢舒颖, 刘宁, 魏璐华, 等. 产后出血预防及管理的最佳证据总结[J]. 护理学报, 2020, 27(12):18-22.
	Lu SY, Liu N, Wei LH, et al. Best evidence summary regarding prevention and management of postpartum hemorrhage[J]. J Nurs China, 2020, 27(12):18-22.
[11]	蔺莉. 妊娠合并肾脏疾病的分类及诊治特点[J]. 实用妇产科杂志, 2015, 31(10):723-725.
	Lin L. Classification,diagnosis and treatment of pregnancy com-plicated with renal disease[J]. J Pract Obstet Gynecol, 2015, 31(10):723-725.
[12]	Unar-Munguía M, Torres-Mejía G, Colchero MA, et al. Breastfeeding mode and risk of breast cancer:a dose-response meta-analysis[J]. J Hum Lact, 2017, 33(2):422-434. DOI PMID
[13]	Parkash A, Haider N, Khoso ZA, et al. Frequency,causes and outcome of neonates with respiratory distress admitted to neonatal intensive care unit,National Institute of Child Health,Karachi[J]. J Pak Med Assoc, 2015, 65(7):771-775. PMID
[14]	许芊芊, 杨慧霞. 孕前糖尿病合并妊娠临床管理新进展[J]. 中华围产医学杂志, 2020, 23(2):114-120.
	Xu QQ, Yang HX. Advances in clinical management of pregnant women with preexisting diabetes[J]. Chin J perinatal med, 2020, 23(2):114-120.

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