注射胰岛素治疗妊娠期糖尿病的孕周选择和妊娠结局分析

Analysis of Pregnancy Outcome in Insulin Injection for Gestational Diabetes in Different Gestational Age

目的观察不同孕周注射胰岛素对于妊娠期糖尿病的疗效及妊娠结局的影响。方法回顾分析84例妊娠期糖尿病接受胰岛素治疗的患者资料,按起始接受胰岛素治疗的孕周时间分为早期治疗组(n=40)和晚期治疗组(n=44)。两组的摄入总热量不超过35 k J·kg^(-1)·d^(-1),摄入的食物分配为碳水化合物:脂肪:蛋白=11:5:4。给予生物合成人工胰岛素注射液4~6单位按一定比例分时注射。观察两组患者初诊时及分娩前空腹血糖及餐后2 h血糖水平,比较两组的妊娠结局及新生儿情况。结果分娩时,早期治疗组患者空腹血糖、餐后2 h血糖水平皆显著低于晚期治疗组(P<0.05)。早期治疗组在分娩期,餐后2 h血糖值相对于空腹血糖的升高幅度低于晚期治疗组(P<0.05)。剖宫产数量及胎儿窘迫数量两组之间并无差异,早期治疗组巨大儿的数量显著少于晚期治疗组同时早期治疗组新生儿5 min的Apgar评分高于晚期治疗组,两组差异皆有统计意义(P<0.05)。结论尽早给予胰岛素治疗妊娠期糖尿病,可有效控制血糖水平,改善宫内不良环境,降低妊娠不良结局。

Objective To observe the efficacy and safety of insulin in the treatment of gestational diabetes in different gestational age. Methods The data of 84 women with gestational diabetes were retrospectively collected, and divided into early treatment group （ n=40） and late treatment group （ n=44） based on first use o f insulin in different gestational age. All patients received controlled diet （calorie intake no more than 35 kJ.kg- 1. d-1, carbohydrate, fat and protein were distributed by 11：4：5）. Insulin injection started with 4-6 units before meals and at bedtime by 4：2：3：1 depending on the levels of fast blood glucose and postprandial 2 h blood glucose, patients were divided into early treatment group （first injection before pregnant 28 week） and late treatment group （first injection group after pregnant 28 week）. The data of fast blood glucose and postprandial 2 h blood glucose at the first and delivery, pregnancy outcomes and neonatal conditions were collected of 2 groups. Results During delivery, the fast blood glucose and postprandial 2 h blood glucose levels in the early treatment group were significantly lower than those in the late treatment group （P〈0.05）. In the early treatment group, the improvement of postprandial 2 h blood glucose level vs. fasting was significantly lower than that in the late treatment group （P〈0.05）. The number of cesarean section and fetal distress number between the two groups were not significantly different. The number of macrosomia of early treatment group was significantly less than the late treatment group, and the 5 min neonatal Apgar score of early treatment was significantly higher than late treatment group （ P〈0.05）. Conclusion Treatment with insulin before pregnant 28 weeks can effectively control the blood glucose, improve the adverse uterus environment and pregnancy outcomes with safety.