不同时期应用胰岛素治疗妊娠合并糖尿病的疗效观察

Observation on Curative Effects of Insulin Treating Gestational Diabetes Mellitus in Different Periods

目的探讨不同时期应用胰岛素治疗妊娠合并糖尿病(GDM)的疗效。方法将98例GMD患者分为早期治疗组(32周及32周前应用胰岛素治疗)49例与晚期治疗组(32周后应用胰岛素治疗)49例。观察对比两组患者治疗前及治疗后血糖水平、尿酮阳性率,观察两组的子宫动脉血流动力学指标变化及母婴结局。结果 1早期治疗组治疗后空腹血糖、餐后2 h血糖水平均低于晚期治疗组及治疗前(P<0.05)。2早期治疗组治疗后尿酮阳性率低于晚期治疗组及治疗前(P<0.05)。3早期治疗组PI及RI水平显著低于晚期治疗组(P<0.05)。4晚期治疗组剖宫产率及早产率高于早期治疗组(P<0.05);早期治疗组酮症、胎儿窘迫的发生率低于晚期治疗组(P<0.05)。结论 GDM患者早期应用胰岛素治疗可以有效控制血糖水平,改善围生儿结局,保障妊娠质量,适于临床应用。

Objective To discuss the curative effects of using insulin to treat gestational diabetes mellitus（GDM） in different periods.Methods 98 cases of GDM patients were randomly divided into the early treatment group（n = 49, applying insulin within 32 weeks） and the late treatment group（n = 49, applying insulin after 32 weeks）. The blood glucose levels and urine ketone positive rates before and after treatment, blood flow velocity indexes of uterine artery, and maternal and neonatal outcomes of two groups were observed and compared.Results 1 The fasting plasma glucose（FPG） and 2-hour plasma glucose（2h PG） after treatment of early treatment group decreased significantly（P 0.05）, and significantly lower than those of late treatment group after treatment（P 0.05）. 2The urine ketone positive rate after treatment of early treatment group decreased significantly（P 0.05）, and significantly lower than that of late treatment group（P 0.05）.3The levels of pulsatility index（PI） and resistance index（RI） of early treatment group were significantly lower than those of late treatment group（P 0.05）. 4The rates of cesarean section and preterm birth, and incidences of fetosis and fetal distress of early treatment group were significantly lower than those of late treatment group（P 0.05）. Conclusions Early application of insulin for GDM patients can effectively control the blood glucose level, improve perinatal outcome and guarantee the quality of pregnancy.