课件：昆明学院双语查房妊娠期糖尿病.ppt

9/1/2019,大美昆院,9/1/2019,指导老师： 徐建 阮海英 刘春梅 承办：妇产儿教研组,昆明学院 云南省第二人民医院 双语教学查房,目 录,Basic information of the patient,GDM的定义,床号：22床 姓名：翟艳 住院号：1470825 年龄：29岁 入院时间：2014年07月12日15时00分 诊断： 1、G1P0孕39+5周头位临产； 2、妊娠期糖尿病,一、病历基本情况 (basic information of the patient).,Bed no.22 Name：Zhai Yan AD：1470825 Age：29 Admission time：July 12,2014,15 Diagnosis： 1、G1P0, 39+5weeks of gestation, head in labor； 2、diabetes during pregnancy,主诉（Main suit）：停经9月余，发现血糖异常3月余， 临预产 Menelipse over 9 months, blood sugar abnormal over 3 months and the due date draws near. 现病史（medical record）： 此次第1次怀孕，平素月经规律正常。LMP：2013年10月07日。 孕1月余自测尿HCG阳性，孕2月至我院行B超示宫内妊娠。 孕2月开始有恶心、呕吐、厌食等症状，3月时消失。 孕4月自觉胎动至今。孕期无头痛、头晕、心悸、胸闷史。 It is the first time pregnancy. The last menstrual cycles was on October 7, 2013. The HCG shows positive when she tested after one month pregnancy.,简要病史 (the brief history),简易OGTT血糖为：5.77mmol/L 11.12mmol/L 8.75mmol/L OGTT shows blood sugar: 5.77Milli Moore per liter ， 11.12Milli Moore per liter ， 8.75Milli Moore per liter 。,家族史(The family history)：母亲患有糖尿病。 The family history: mother have diabetes.,简要病史 (the brief history),G,目 录,Laboratory tests Physical check,Laboratory tests,实验室检查,Laboratory tests,50g 葡萄糖 + 200ml 水 一小时后抽血,糖筛查:,Laboratory tests,实验室检查,Laboratory tests,50g glucose + 200ml water Blood in an hour,Sugar screening ：,翟女士我院产检时行OGTT血糖为： 5.77mmol/L，11.3mmol/L，8.75mmol/L。 4、肝肾功能检查，24小时尿蛋白定量，尿酮体及眼底等相关检查；,实验室检查,Laboratory tests,禁食12小时，取空腹血，再用300毫升水冲75克葡萄糖口服，服糖后1、2、3小时取血 空腹 1小时 2小时 3小时 国际 5.6 10.3 8.6 6.7 OGTT两点异常，确诊为GDM；一点异常诊为妊娠期糖耐量异常,糖耐量（OGTT）,Ms. Zhai from their prenatal OGTT blood sugar for: 5.77mmol/L，11.3mmol/L，8.75mmol/L。 4、Quantitative kidney function, 24 hour urine protein, urine ketone body and fundus examination related to;,实验室检查,Laboratory tests,糖耐量（OGTT）,Taking on an empty stomach blood fasting 12 hours, and then with 300 ml water, 75 g oral glucose, 1, 2, 3 hours after taking sugar in blood empty stomach 1h 2h 3h 5.6 10.3 8.6 6.7 Abnormal OGTT at two o clock, diagnosed with GDM; A bit of anomaly diagnosed as abnormal glucose tolerance during pregnancy,9/1/2019,Physical check,体格检查,目 录,妊娠合并糖尿病,糖尿病合并妊娠,不足20%,妊娠期糖尿病,80%以上,妊娠合并糖尿病的分类,Gestational diabetes mellitus,Diagnosed with diabietes before pregnancy,Pregnancy associated with diabetes,妊娠期糖尿病：,妊娠期首次发病或发现的糖尿病，包含了一部分妊娠前已患有糖尿病但孕期首次被诊断的病人。,GDM,GDM的定义,The fist onset of gestational diabetes orfound ,contains a part of pregnancy have been in people with diabetes but pregnancy fist diagnosed patients,目 录,The pathogenesis,etiology and pathology,The pathogenesis,etiology and pathology,四、病因病理、发病机制,病因,Cause of disease,2.,生活环境因素,1.,遗传因素,Genetic factors,Living environment factors,The pathogenesis,etiology and pathology,病因病理、发病机制,Pathophysiology,Suffering from diabetes, glucose in the liver, muscle and adipose tissue using reduce and livers output increased was the main reason for the high glycemia.,病理 生理,脂肪 adipose,The pathogenesis,etiology and pathology,病因病理、发病机制,9/1/2019,The pathogenesis,etiology and pathology,病因病理、发病机制,发病机制,Pathology,中晚期抗胰岛素样药物质增加,目 录,The clinical manifestations and the influence on pregnant women,五、临床表现及对孕妇、胎儿的影响,The clinical manifestations and the influence on pregnant women,“三多一少” 即：吃多、喝多、尿多， A little more than three eat more drink more urine 但体重减轻，还伴有呕吐 but weight loss, accompanied by vomiting.,（一）主要临床表现 The main clinical manifestations,临床表现及对孕妇、胎儿的影响,The clinical manifestations and the influence on pregnant women,Effects of gestational diabetes mellitus on pregnant women,1.难产和剖宫产 Dystocia and cesarean section. 2.感染机会增加 Chances of infection increased 3.羊水过多Polyhydramnion 4.有发展为终生糖尿病的危险 there is a risk of developing lifelong diabetes,（二） 妊娠期糖尿病对孕妇的影响,！,！,！,！,临床表现及对孕妇、胎儿的影响,The clinical manifestations and the influence on pregnant women,（四）对新生儿影响 主要包括新生儿呼吸窘迫综合征（NRDS），新生儿低血糖等。 The effects on neonatus generally includes neonatal respiratory distress syndrome,neonatal hypoglycemia and so on.,（三）对胎儿的影响 主要包括：巨大儿，胎儿畸形，早产和胎儿生长受限； The effects on fetus generally includes macrosomia,fetal malformation,premature birth and fetal growth restriction.,9/1/2019,目 录,Treatment,既要控制饮食， 又要保证孕妇及胎儿的正常营养需求。 Demand is to control diet, and to ensure the normal nutritional needs of pregnant women and fetus.,Treatment,六、治疗,1、饮食疗法-diet therapy,要求：,能量供应：33 kcal/kg 碳水化合物：40-50；蛋白质20-30；脂肪30 热量分配为：早25，午30，晚30，睡前15,2019/9/1,26,可编辑,以低至中等强度的有氧运动为主，步行是常用的简单有氧运动。 Give priority to with low to moderate intensity of aerobic exercise, walking is the commonly used simple aerobic exercise.,Treatment,治 疗,2、运动疗法-exercise therapy,3、心理疏导治疗,-psychological counseling treatment,Treatment,治 疗,可改善孕产妇的情绪，积极配合治疗，有效控制血糖，减少临床用药，降低风险。 Improves maternal mood, actively cooperate with treatment, effective control of blood sugar, reduce the clinical drug use, reduce risk.,4、药物治疗-drug treatment,Treatment,治 疗,孕妇禁用口服降糖药，饮食治疗不能控制的用胰岛素控制血糖，显性糖尿病患者孕前用胰岛素治疗。,Insulin therapy is the main treatment method 。,Treatment,治 疗,Treatment,治 疗,5、基因治疗-未来前景 -gene therapy - the future prospects,预测孕产妇患病风险,识别和干预相关基因的发生和发展,Early detection can be effective intervention to prevent the occurrence of complications, individualized treatment in order to more effectively improve gestational diabetes.,目 录,Nursing,【护理诊断/问题】,Nursing diagnosis,七、护 理 Nursing,护理措施,1.严格控制饮食 Strict diet control,Nursing measures,以富含维生素和纤维素食物为主， 降低盐和糖的摄入，少量多餐。 原则：既能为母婴提供必要的营养，又要控制 血糖水平。 Give priority to with foods rich in vitamins and cellulose, reduce the intake of salt and sugar, a small amount of meals. GDM patients diet control principle is both provide necessary for maternal and child nutrition, and to control blood sugar levels.,护理措施,2.加强监测 To encourage proper motion,Nursing measures,密切监测孕妇血压、心率变化及胎心情况。并教会孕妇 。,胎动计数,In the hospital, pay attention to patients sconsciousness, respiratory frequency change and exhaled breath smell.And count church pregnant women quickened .,护理措施,3.重视心理护理 The importance of psychological nursing.,Nursing measures,沟通 鼓励,According to patients condition to select the correct way to communicate, encourage patients correctly treat disease, let family members cooperate to do the ideological work of pregnant women, help pregnant women to establish the confidence of conquer disease, actively cooperate with treatment and nursing.,帮助,护理措施,Nursing measures,护理措施,Nursing measures,注意保暖和吸氧，取脐血监测血糖，预防 低血钙,keep warm and oxygen,prevent low blood calcium,4.新生儿护理,Nenborn care,护理措施,Nursing measures,Health education,5.做好健康教育,(1),健康教育,Health education,妊娠糖尿病患者的焦虑及抑郁症发生率高。因此，我们要指导孕妇听一些优美抒情的音乐或进行瑜伽的练习，使其保持身心愉悦的状态。,Pregnancy anxiety and depression in patient with diabetes have high incidence of. Therefore, we should guide pregnant women to learn emotional self-regulation, to maintain a state of physical and mental pleasure.,健康教育,Health education,健康教育,Health education,健康教育,Health education,（2）,碳水化合物：低糖粗纤维食物 蛋白质：鱼类，禽蛋，乳类，豆制品 蔬菜水果：草莓，菠萝，猕猴桃 维生素，叶酸,健康教育,Health education,Carbohydrates: low sugar crude fibre food Protein: fish, eggs, milk,soyproducts Fruits and vegetables The vitamin, folic acid,（3）,运动指导：增加胰岛素敏感性，减少腹壁脂肪，降低游离脂肪酸水平 原则：不负重、不引起早产，BP140/90mmHg 坐位：上臂及下肢脚踏运动，20分/次；散步，缓慢游泳，太极拳,健康教育,Health education,健康教育,Health education,健康教育,Health education,健康教育,Health education,To guide the pregnant woman proper exercise and rest,20 minutes every day .The principle is :dont load ,not cause premature birth. Slow aerobic exercise such as walking, swimming, and yoga,健康教育,Health education,（4）,教育、指导使孕妇及家庭掌握注射胰岛素正确使用方法及相关知识，掌握剂量、注射部位，每日有序更换，观察注射部位有无硬化。,Education and guidance of the pregnant woman and families to master the correct method of insulin .,讲解注射后的低血糖反应，（如头晕、无力、饥饿、脉快等），若出现这种情况，应即进食含糖食物，及时调整胰岛素用量，同时鼓励其外出携带糖尿病识别卡及糖果，避免发生不良后果。,（5）,Explain after the injection of hypoglycemia, if appear this kind of circumstance, shall eat sugary foods, timely adjust the dose of insulin,健康教育,Health education,健康教育,Health education,健康教育,Health education,健康教育,Health education,（6）孕期母儿监护 1)高危门诊产检：10周前每周1次，28周前2周1次；32周后1周1次，20周增加胰岛素用量 监护项目：监测血糖、尿糖及酮体，每月查糖化血红蛋白、眼底、肾功能 1) prenatal high-risk clinic: 10 weeks ago 1 times a week, 28 weeks ago 2 weeks 1 times; 32 weeks after 1 week 1 time, increase insulin dosage 20 weeks Monitoring project, monitoring the blood sugar, urine sugar and ketone body, monthly check glycosylated hemoglobin, fundus and renal function,健康教育,Health education,健康教育,Health education,2)胎儿监测：B超、胎动、胎盘功能 32周 NST 1次/周，36周后2次/周 胎儿肺成熟：适时入院,2) fetal monitoring: ultrasound, quickening, placental function 32 weeks NST 1 time per week, 2 times per week after 36 weeks Fetal lung maturity: timely to the hospital,（7）告诉产妇及其家属要严密的观察婴儿的情况，一定要注意保暖及其卫生情况，且情况轻者最好选择母乳喂养，以提高胎儿