妊娠期糖代谢异常门诊干预对母婴结局影响的研究

Influence of intervention on abnormal glucose metabolism on maternal and neonatal outcomes

目的探讨妊娠期糖代谢异常的门诊干预措施及对母婴结局的影响。方法对2011年1月至2014年6月间在丽水市人民医院住院分娩的糖代谢异常产妇64例的临床资料进行回顾性分析,其中38例自早孕开始定期进行产前检查、监测、干预治疗至分娩作为干预组;其余26例无正规医院详细产检记录来院分娩者作为对照组。对比两组孕妇妊娠合并症、妊娠结局以及新生儿情况。结果干预组在干预前空腹血糖(FBG)、口服葡萄糖耐量试验(OGTT)2h与对照组比较均无统计学差异(t值分别为0.078、0.102,均P>0.05),干预组干预后FBG、OGTT 2h较干预前均显著降低(t值分别为0.530、2.632,均P<0.05),且干预后均显著低于对照组(t值分别为2.528、2.638,均P<0.05)。对照组孕妇妊娠高血压疾病、羊水过多、剖宫产率均显著高于干预组(x^2值分别为6.458、5.675、4.992,均P<0.05),两组孕妇泌尿系感染、产后出血发生率比较均无统计学差异(x^2值分别为3.486、0.084,均P>0.05)。对照组巨大儿、早产儿、新生儿低血糖和新生儿肺炎发生率均显著高于干预组(x^2值分别为4.357、10.114、10.114、4.600,均P<0.05),两组的胎儿窘迫发生率比较无统计学差异(x^2=2.090,P>0.05)。结论妊娠期糖代谢异常是产科高危因素之一,通过门诊干预可以有效的控制孕妇血糖水平,改善母婴结局。

Objective To investigate the clinical intervention method for pregnant women with abnormal glucose metabolism and its influence on maternal and neonatal outcomes. Methods Retrospective analysis was conducted on the clinical data of 64 cases of abnormal glucose metabolism delivering during the period of January 2011 to June 2014 in Lishui People＇ s Hospital, including 38 cases in intervention group who taking regular antenatal examination from early pregnancy, being monitored and receiving intervention till labor; and the other 26 patients without regular hospital detailed check record in control group. Pregnancy complications, pregnancy outcomes and neonatal status of two groups were compared. Results Before intervention, the fasting blood glucose （FBG）, oral glucose tolerance test （OGTT） 2h in the intervention group showed no significant differences compared with the control group （t value was 0. 078 and 0. 102, respectively, both P 〉 0.05）. They were significantly decreased after intervention in the intervention group （t value was 0. 530 and 2. 632, respectively, both P 〈 0. 05 ）, and they were significantly lower than those of the control group （ t value was 2. 528 and 2. 638, respectively, both P 〈 0. 05 ）. The incidence of pregnancy induced hypertension, polyhydramnios and cesarean secti＇on rate were significantly higher in the control group than those in the intervention group （χ^2 value was 6. 458, 5. 675 and 4. 992, respectively, all P 〈 0.05 ）, but there were no significant differences in urinary tract infection and the incidence of postpartum hemorrhage between two groups （χ^2 value was 3. 486 and 0. 084, respectively, both P 〉 0.05 ）. Compared with the intervention group, the incidence of macrosomia, premature birth, neonatal hypoglycemia and neonatal pneumonia was significantly higher in the control group （χ^2 value was 4. 357, 10.114, 10.114 and 4.600, respectively, all P 〈 0.05 ）, but the incidence of fetal distress was not significantly different （χ^2 = 2.090, P 〉 0.05 ）. Conclusion Abnormal glucose metabolism during pregnancy is one of the obstetric risk factors. Clinical intervention can effectively control blood glucose level and improve maternal and neonatal outcomes.