以质量求发展,以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (3): 31-36.doi: 10.16460/j.issn1008-9969.2020.03.031

• 循证护理 • 上一篇    下一篇

妊娠期糖尿病产妇分娩新生儿低血糖管理的最佳证据总结

王焕焕1, 程湘玮1, 王培红1, 丁颖1, 周英凤2, 张纹1, 熊彩霞1, 吕永利1, 屠凤鸣1   

  1. 1.华中科技大学同济医学院附属协和医院 妇产科,湖北 武汉 430022;
    2.复旦大学 护理学院,上海 200032
  • 收稿日期:2019-11-15 出版日期:2020-02-10 发布日期:2020-07-20
  • 通讯作者: 程湘玮(1980-),女,湖北武汉人,硕士研究生,主管护师,护士长。E-mail:excellentzh_w199@163.com
  • 作者简介:王焕焕(1990-),女,湖北武汉人,硕士研究生,护师。
  • 基金资助:
    复旦大学循证护理中心证据转化与临床应用项目(Fudanebn201902)

Best Evidence Summary for Management of Hypoglycaemia in Neonates of Mother with Gestational Diabetes Mellitus

WANG Huan-huan1, CHENG Xiang-wei1, WANG Pei-hong1, DING Ying1, ZHOU Ying-feng2, ZHANG Wen1, XIONG Cai-xia1, LV Yong-li1, TU Feng-ming1   

  1. 1. Dept. of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022,China;
    2. School of Nursing, Fudan University, Shanghai 200032, China
  • Received:2019-11-15 Online:2020-02-10 Published:2020-07-20

摘要: 目的 检索并梳理妊娠期糖尿病产妇分娩新生儿低血糖管理的相关证据,为临床实践提供参考,以提高妊娠期糖尿病产妇分娩新生儿低血糖早期识别率、规范低血糖管理流程,提升母婴同室妊娠期糖尿病产妇分娩新生儿护理质量。方法 采取循证护理的方法,针对妊娠期糖尿病产妇分娩新生儿低血糖管理提出循证问题,检索相关文献,采用澳大利亚JBI循证卫生保健中心的文献质量评价标准及证据分级系统,对检索的各类研究进行评价及分级。结果 本研究最终纳入11篇文献,其中包含2篇临床决策,1篇证据总结,7篇指南,1篇系统评价,共总结出20条妊娠期糖尿病产妇分娩新生儿低血糖管理相关证据,包含低血糖预防、血糖监测、低血糖治疗及转科时机、出院及随访、健康教育及系统支持5个方面。结论 本研究总结了目前关于妊娠期糖尿病产妇分娩新生儿低血糖管理的最佳证据,为相关科室护士及管理者提供一定的循证依据。通过最佳证据的应用,有益于妊娠期糖尿病产妇分娩新生儿低血糖的科学管理,提升护理质量。

关键词: 妊娠期糖尿病, 新生儿, 低血糖, 循证护理学

Abstract: Objective To search and obtain relevant evidence of management of hypoglycaemia in neonates of mother with gestational diabetes mellitus (GDM) and to provide reference for clinical practice to improve early recognition rate, standardize the management process and improve the nursing quality of neonatal hypoglycemia. Methods The method of evidence-based nursing was adopted to put forward evidence-based problems to the management of hypoglycemia in neonates of mothers with GDM. JBI evidence appraisal and recommendation system were used to evaluate the quality of the studies and rate the evidence. Results Totally 11 articles were selected, including 2 of clinical decision-making, 1 evidence summary, 7 guidelines and 1 systematic assessment and 20 evidences were summarized out including prevention of hypoglycemia, detection methods and timing of blood glucose, treatment and transfer of hypoglycemia, discharge and follow-up, health guidance and systematic support. Conclusion This study summarizes the best evidence for management of hypoglycemia in neonates of mother with GDM, and provides some evidence-based basis for clinical nurses and nursing administrators. Ultimately through adapting the best evidence, it is beneficial to the scientific management of hypoglycemia in neonates of mother with GDM, and the improvement of quality of nursing.

Key words: gestational diabetes mellitus, neonate, hypoglycemia, evidence-based nursing

中图分类号: 

  • R473.72
[1] 复旦大学Joanna Briggs循证护理合作中心.妊娠期糖尿病临床护理实践指南[Z].2018..妊娠期糖尿病临床护理实践指南[Z].2018.http://nursing.ebn.fudan.edu.cn/WebContent_list.aspx?BID=263&ShowID=10439&SID=279&SID1=0&SID2=0.
[2] The International Diabetes Federation. IDF Diabetes Atlas Eighth edition[Z].2017:2018.
[3] Cordero L, Treuer S H, Landon M B, et al.Management of Infants of Diabetic Mothers[J]. Arch Pediatr Adolesc Med,1998,152(3):249-254.
[4] McKinlay CJ,Alsweiler JM,Ansell JM,et al.Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years[J]. N Engl J Med,2015,373(16):1507-1518.DOI:10.1056/NEJMoa1504909.
[5] McKinlay CJD, Alsweiler JM, Anstice NS, et al. Association of Neonatal Glycemia with Neurodevelopmental Outcomes at 4.5 Years[J].JAMA Pediatr,2017,17(10):972-983.DOI:10.1001/jamapediatrics.2017.1579.
[6] 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.
[7] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[8] Bayley L, Haynes RB, Dicenso A.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J].Evidence-based Nursing,2009,12(4):99-101.
[9] 杨中善,许妮娜,詹昱新,等.住院患者规范化身体约束管理最佳证据总结[J].护理学报, 2019,26(4):31-36.DOI:10.16460/j.issn1008-9969.2019.04.031.
[10] 谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.DOI:10.3736/jcim20120206.
[11] The Joanna Briggs Institute. Critical Appraisal Checklist for Text and Opinion/Randomized Controlled Trials/Systematic Reviews and Research Syntheses[EB/OL].[2019-12-18].http://joannabriggs.org/research/critical-appraisal-tools.html.
[12] 李立玉,王轶,王志稳.痴呆患者进食问题评估与管理指南的系统评价[J].中华护理杂志,2019,54(4):581-588. DOI:10.3761/j.issn.0254-1769.2019.04.022.
[13] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志, 2015, 30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[14] Rozance PJ.Pathogenesis,Screening,and Diagnosis of Neonatal Hypoglycemia[EB/OL].(2019-06-26).https://www.uptodate.com/contents/pathogenesis-screening-and-diagnosis-of-neonatal-hypoglycemia?csi=7d69af63-e715-457f-8e8b-6f9d0586e45b&source=default&-display_rank=1.
[15] Rozance PJ. Management and Outcome of Neonatal Hypoglycemia[EB/OL].(2019-04-29).https://www.uptodate.com/contents/management-and-outcome-of-neonatal-hypoglycemia?csi=d3a3a0aa-0e08-47a4-bff3-ee16fc473017&source= default&-display_rank=1.
[16] LKD Le.Infant of a Woman with Diabetes: Management[J].The Joanna Briggs Institute EBP Database,JBI@Ovid,2019:JBI7818.
[17] National Collaborating Centre for Women's and Children's Health.Diabetes in Pregnancy:Management of Diabetes and Its Complications from Preconception to the Postnatal Period[EB/OL].(2015-02-01)[2018-04-25].https://www.nice.org.uk/guidance/ng3.
[18] Ministry of Health. Screening,Diagnosis and Management of Gestational Diabetes in New Zealand:A Clinical Practice Guideline[M].Wellington:Ministry of Health,2014.
[19] Scottish Intercollegiate Guidelines Network. Management of Diabetes:A National Clinical Guideline[EB/OL].(2013-11-01)[2018-04-25]. http://www.sign.ac.uk/assets/sign116.pdf.
[20] Endocrine Society.Diabetes and Pregnancy:An Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab,2013,98(11):4227-4249.DOI:10.1210/jc.2013-2465.
[21] Queensland Clinical Guidelines. Guideline:Newborn Hypoglycaemia[EB/OL].(2015-06-18)[2019-07-30]https://www.health.qld.gov.au/data/assets/pdf_file/0019/142156/g-hypogly.pdf.
[22] Thornton PS, Stanley CA, De Leon DD,et al.Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates,Infants,and Children[J]. J Pediatr,2015,167(2):238-245.DOI:10.1016/j.jpeds.2015.03.057.
[23] Weston PJ, Harris DL, Battin M,et al.Oral Dextrose Gel for the Treatment of Hypoglycaemia in Newborn Infants[J]. Cochrane Database Syst Rev, 2016(5):CD011027. DOI:10.1002/14651858.CD011027.pub2.
[24] Weston PJ, Harris DL, Harding JE.Dextrose gel Treatment does not Impair Subsequent Feeding[J]. Arch Dis Child Fetal Neonatal Ed, 2017(102):F539.
[25] Beardsall K,Vanhaesebrouck S,Ogilvy-Stuart AL,et al.Validation of the Continuous Glucose Monitoring Sensor in Preterm Infants[J].Arch Dis Child Fetal Neonatal Ed, 2013(98):F136.DOI:10.1136/archdischild-2012-301661.
[26] Adamkin DH.Clinical Report-Postnatal Glucose Homeostasis in Late-preterm and Term Infants[J]. Pediatrics,2011,127(3):575-579.DOI:10.1542/peds.2010-3851.
[27] Middleton P, Crowther CA, Simmonds L.Different Intensities of Glycaemic Control for Pregnant Women with Pre-existing Diabetes[J]. Cochrane Database Syst Rev,2016,9(8):CD008540.DOI:10.1002/14651858.CD008540.pub4.
[1] 贺芳, 温秀兰, 林艳, 刘会, 郭晓萍, 张喆. 新生儿重症监护病房噪音水平调查与对策[J]. 护理学报, 2020, 27(12): 42-45.
[2] 马翠翠, 张玲, 李蓉. 提高NICU肠外营养液配置准确率的品管圈实践[J]. 护理学报, 2019, 26(21): 18-20.
[3] 栗娟, 陈秀荣. 1型糖尿病儿童/青少年父母低血糖恐惧感影响因素研究进展[J]. 护理学报, 2019, 26(21): 31-35.
[4] 陈慧, 潘菲. 1例新生儿脓疱病致皮肤破损的护理[J]. 护理学报, 2019, 26(20): 53-54.
[5] 阮景, 张颖, 林慧佳. E型固定法在新生儿经口气管插管中的应用[J]. 护理学报, 2019, 26(20): 67-68.
[6] 聂莉莉, 邓春贵, 刘斌, 叶芳兰, 邱建武. 防撞鸟巢式护理对新生儿黄疸蓝光治疗的效果观察[J]. 护理学报, 2019, 26(16): 59-62.
[7] 刘芳, 万青, 石立雅, 史静姝, 罗丽波, 王培红, 夏文芳. 糖尿病专科护士主导多学科团队在妊娠期糖尿病患者的管理实践[J]. 护理学报, 2019, 26(14): 14-18.
[8] 裴一洁, 党娟, 凌继祖, 杨学梅. 1例新生儿下肢PICC致腰背部脓肿的原因分析与预防对策[J]. 护理学报, 2019, 26(13): 69-71.
[9] 王瑞娜, 赖晓帆, 刘秋利, 张婷婷, 梁琼文, 倪丹霞. 预防新生儿足底采血疼痛的最佳证据总结[J]. 护理学报, 2019, 26(11): 45-48.
[10] 吴祝凤, 殷彩欣, 徐琼, 崔诗敏, 徐茜雯. 母婴皮肤接触方法及实施现状[J]. 护理学报, 2019, 26(1): 36-39.
[11] 刘艳, 周燕, 卢筱华, 赵宛鄂, 吴鸿艳, 刘喻, 李艳萍. 非内分泌科96例胰岛素泵治疗患者低血糖原因分析及对策[J]. 护理学报, 2019, 26(1): 55-58.
[12] 陈钰仪. 自然受孕与辅助生殖受孕妊娠期糖尿病患者围生期结局的回顾性队列研究[J]. 护理学报, 2019, 26(1): 65-67.
[13] 黎静,陈伟菊,黄东喜,丘保华,张诗毅,李月仪. 93例孕28周前妊娠期糖尿病患者自我管理现状及影响因素分析[J]. 护理学报, 2018, 25(6): 37-40.
[14] 许颖,蒋小平,林楠,雷若冰. 697名无陪护新生儿病区护士实施身体评估影响因素的现状调查[J]. 护理学报, 2018, 25(4): 45-48.
[15] 邹丽, 郑雅宁, 吴瑜玲. 剖宫产术后医用皮肤接触组合母子衣的研制[J]. 护理学报, 2018, 25(22): 77-78.
Viewed
Full text


Abstract

Cited

  Shared   
[1] 夏婷婷,王淑云,杨富国,马蕙,尹春岚,王广宁,范海霞,李瑶瑶. 肠造口患者造口压力及希望水平与自我管理的相关性研究[J]. 护理学报, 2018, 25(18): 8 -11 .
[2] 王婧,刘芮寒,巩文花,邹宇,王宇,王芳. 自我效能在2型糖尿病患者社会支持和心理弹性的中介作用[J]. 护理学报, 2018, 25(18): 12 -15 .
[3] 蒋文春,温贤秀,顾凤娇. 应用德尔菲法和层次分析法构建血液透析室护理管理质量评价标准体系[J]. 护理学报, 2018, 25(18): 16 -21 .
[4] 刘丽萍, 吴艳妮, 从维莲, 胡明钰, 李晓霞, 周春兰. 癌症患者化疗期自我护理体验质性研究的系统评价[J]. 护理学报, 2020, 27(7): 1 -6 .
[5] 孙文玉, 毕鸿雁. 视觉追踪训练对脑卒中患者步行功能与日常生活能力的影响[J]. 护理学报, 2020, 27(7): 7 -10 .
[6] 陈芳芳, 桂意华, 周艳, 任远, 黄琦, 郑亚华. 环状软骨上喉部分切除术患者呼吸-吞咽协调训练效果观察[J]. 护理学报, 2020, 27(7): 11 -14 .
[7] 冉丽伟, 董渠龙, 李桂青, 张岩, 孙超颖, 刘洪青, 苏玉美, 史海霞. 发展取向的绩效考核对助产士行为的影响[J]. 护理学报, 2019, 26(18): 12 -14 .
[8] 李艳红, 刘宇英, 张海英. 健康管理中心护理人力资源短缺的管理实践[J]. 护理学报, 2019, 26(18): 15 -17 .
[9] 高泽宇, 高晶晶, 周颖, 周文琦. 基于互联网技术的护士培训与考试平台的建立与使用[J]. 护理学报, 2019, 26(18): 18 -21 .
[10] 何文斌, 廖尧, 尹熙, 杨茜, 胡君娥, 严妍, 周雪果, 姚小云, 陈红宇. 心脏瓣膜置换术后患者Ⅰ期心脏康复的最佳证据总结[J]. 护理学报, 2019, 26(18): 32 -36 .