早期护理干预调整甲状腺素剂量对降低甲减孕妇及胎儿的危害研究(1)
摘要：目的 分析妊娠期亚临床甲状腺降低孕妇甲状腺激素剂量的调整时间和规律，以及实施早期护理干预对胎儿的影响。方法 60例怀孕2个月内的患者，根据孕前是否发现甲状腺减低症分为早期干预组和对照组，每组各30例；早期干预组患者及时接受左旋甲状腺素片治疗，并接受早期护理干预调整剂量；对照组患者为早孕检查时发现甲状腺功能减退患者，在发现时开始接受甲状腺素的治疗。结果 对照组不同孕月甲状腺激素用量显著高于干预组(P<0.05)；干预组激素达标孕周显著早于对照组(P<0.05)；干预组促甲状腺素达标孕周显著早于对照组(P<0.05)；两组患者分娩后婴儿未发现异常，但对照组的剖宫产率显著高于早期干预组(P<0.05)。结论 妊娠早期应当尽快明确甲状腺功能，同时对患者甲状腺水平进行监测，并进行及时调整，实施早期护理干预，减少甲状腺功能减退所致的妊娠不良结局。
关键词：早期护理干预；妊娠；甲状腺减低；调整剂量
Abstract：Objective To analyze the adjustment time and the rule of thyroid hormone dose in pregnant women with subclinical hypothyroidism，and to study the effect of early nursing intervention on the fetus.Methods 60 cases of pregnancy within 2 months of patients，according to their prepregnant whether thyroid reduced disease divided into the early intervention group and control group，each with 30 cases in each；early intervention patients receive timely levothyroxine treatment，and received early nursing intervention dose adjustment；in the control group，patients in early pregnancy check found in hypothyroid patients.At the time of discovery began receiving thyroxine treatment.Results Control group in different months of pregnancy thyroid hormone dosage was significantly higher than that in the intervention group(P<0.05)；intervention in the hormone group standard gestational weeks significantly earlier than the control group(P<0.05)；intervention group promoting thyroxine standard gestational weeks significantly earlier than the control group(P<0.05)；delivery of two groups after the baby was not abnormal，but the control group the rate of cesarean section was significantly higher than that in the early intervention group(P<0.05).Conclusion Early pregnancy should be as soon as possible a clear thyroid function and monitoring of patients with thyroid levels at the same time，and timely adjustment and implementation of early nursing intervention，reduce hypothyroidism caused by adverse pregnancy outcomes.
Key words：Early nursing intervention；Pregnancy；Hypothyroidism；Adjusting dose
妊娠合并甲状腺功能减退症常因症状轻微而被忽视，但其对妊娠的不良影响却值得关注[1]。相关研究显示[2]，育龄期妇女和妊娠期合并甲减的病例较为多见。如果在妊娠期间得不到及时有效的治疗，对胎儿发育会产生较大的影响，可发生妊娠高血压综合征等[3]。
1 资料与方法
1.1一般资料 回顾性分析2015年1月～2016年1月就诊我院的60例怀孕2个月内的患者，两组发病史均小于1年。根据孕前是否发现甲状腺减低症分为早期干预组和对照组，每组各30例。早期干预组于妊娠前已知甲状腺功能减退，且有生育需求，平均年龄(23.9±2.6)岁；对照组为早孕检查时发现的甲状腺功能减退，平均年龄(24.1±2.2)岁。
1.2诊断标准 按照中国甲状腺疾病诊治指南推荐的参考标准[4]：甲状腺激素处于正常水平低限，将2.5 mIU/L作为妊娠早期促甲状腺激素(TSH)的上限。
1.3早期护理方法 早期护理干预组为妊娠前在接受甲状腺功能检测时发现有甲减，在妊娠过程中监测甲状腺功能，并对其进行护理干预；介绍甲减的症状和体征，以及妊娠后可能出现的体征、危害，耐心倾听患者诉说病史，掌握患者心理动态，病情动态和所处社会环境，并向患者家属介绍根本措施及替代治疗效果，指引患者积极的接受治疗，帮助其消除悲观情绪[5]。, 百拇医药(刘安敏 刘兰 朱艳 程锦楠)
关键词：早期护理干预；妊娠；甲状腺减低；调整剂量
Abstract：Objective To analyze the adjustment time and the rule of thyroid hormone dose in pregnant women with subclinical hypothyroidism，and to study the effect of early nursing intervention on the fetus.Methods 60 cases of pregnancy within 2 months of patients，according to their prepregnant whether thyroid reduced disease divided into the early intervention group and control group，each with 30 cases in each；early intervention patients receive timely levothyroxine treatment，and received early nursing intervention dose adjustment；in the control group，patients in early pregnancy check found in hypothyroid patients.At the time of discovery began receiving thyroxine treatment.Results Control group in different months of pregnancy thyroid hormone dosage was significantly higher than that in the intervention group(P<0.05)；intervention in the hormone group standard gestational weeks significantly earlier than the control group(P<0.05)；intervention group promoting thyroxine standard gestational weeks significantly earlier than the control group(P<0.05)；delivery of two groups after the baby was not abnormal，but the control group the rate of cesarean section was significantly higher than that in the early intervention group(P<0.05).Conclusion Early pregnancy should be as soon as possible a clear thyroid function and monitoring of patients with thyroid levels at the same time，and timely adjustment and implementation of early nursing intervention，reduce hypothyroidism caused by adverse pregnancy outcomes.
Key words：Early nursing intervention；Pregnancy；Hypothyroidism；Adjusting dose
妊娠合并甲状腺功能减退症常因症状轻微而被忽视，但其对妊娠的不良影响却值得关注[1]。相关研究显示[2]，育龄期妇女和妊娠期合并甲减的病例较为多见。如果在妊娠期间得不到及时有效的治疗，对胎儿发育会产生较大的影响，可发生妊娠高血压综合征等[3]。
1 资料与方法
1.1一般资料 回顾性分析2015年1月～2016年1月就诊我院的60例怀孕2个月内的患者，两组发病史均小于1年。根据孕前是否发现甲状腺减低症分为早期干预组和对照组，每组各30例。早期干预组于妊娠前已知甲状腺功能减退，且有生育需求，平均年龄(23.9±2.6)岁；对照组为早孕检查时发现的甲状腺功能减退，平均年龄(24.1±2.2)岁。
1.2诊断标准 按照中国甲状腺疾病诊治指南推荐的参考标准[4]：甲状腺激素处于正常水平低限，将2.5 mIU/L作为妊娠早期促甲状腺激素(TSH)的上限。
1.3早期护理方法 早期护理干预组为妊娠前在接受甲状腺功能检测时发现有甲减，在妊娠过程中监测甲状腺功能，并对其进行护理干预；介绍甲减的症状和体征，以及妊娠后可能出现的体征、危害，耐心倾听患者诉说病史，掌握患者心理动态，病情动态和所处社会环境，并向患者家属介绍根本措施及替代治疗效果，指引患者积极的接受治疗，帮助其消除悲观情绪[5]。, 百拇医药(刘安敏 刘兰 朱艳 程锦楠)