动态血糖监测联合胰岛素泵治疗妊娠期糖尿病临床研究

Clinical effect of insulin pump therapy under dynamic monitoring of blood glucose in treatment of gestational diabetes

目的观察胰岛素泵联合动态血糖监测治疗妊娠期糖尿病的临床效果。方法 2014年10月至2016年10月住院的70例妊娠期糖尿病患者入选,随机分为对照组(皮下胰岛素治疗)和观察组(胰岛素泵治疗),每3个月动态血糖监测1次,每次72 h。比较两组患者治疗前后的血糖水平、血糖漂移情况和妊娠结局,平均随访期限5.2个月。结果治疗后,观察组的餐后2 h血糖[(6.3±2.1)mmol/L vs(9.8±2.8)mmol/L]、Hb A1c[(6.1±0.8)%vs(7.1±1.1)%]、血糖最高值[(9.7±3.2)mmol/L vs(10.9±3.6)mmol/L]、平均血糖漂移幅度[(1.98±0.13)mmol/L vs(2.67±0.35)mmol/L]以及低血糖发生率(12.5%vs 25%)均明显低于对照组(P<0.05)。对照组与观察组新生儿呼吸窘迫症(0例vs 0例)、新生儿高胆红素血症(0例vs 0例)和妊娠期高血压综合征(1例vs 1例)的发生率差异无统计学意义(P>0.05),但观察组患者剖宫产比例明显低于对照组(P<0.05)。结论胰岛素泵联合动态血糖监测治疗妊娠期糖尿病临床效果肯定,安全可靠,并有助于降低剖宫产率,值得临床推广应用。

Objective To evaluate the clinical effect of insulin pump under dynamic monitoring of blood glucose in treatment of gestational diabetes mellitus.Methods Seventy patients with gestational diabetes admitted from October 2014 to October 2016 were randomly divided into study group and control group.All patients were treated with continuous glucose monitoring, every three months;the control group was treated with insulin injection daily, while the study group was treated with insulin pump therapy.The blood glucose levels, blood glucose drift and pregnancy outcomes were compared between two groups.The average time of follow-up was 5.2 months.Results After treatment, the 2h-postprandial plasma glucose, HbA1c, average blood glucose drift and the incidence of hypoglycemia in the observation group were （6.3＆#177;2.1） mmol/L, （6.1＆#177;1.1）%, （1.98＆#177;0.13） mmol/L, and 12.5%, respectively, which were significantly lower than those in control group（P〈0.05）;There was no significant difference in the neonatal respiratory distress syndrome（0 vs 0）, neonatal hyperbilirubinemia（0 vs 0）and gestational hypertension（1 vs 1） between the two groups （P〉0.05）;The proportion of cesarean section in study group was 18.8%, which was significantly lower than in control group （P〈0.05）.Conclusion The insulin pump shows satisfactory clinical efficacy in the treatment of gestational diabetes, and it can also reduce the blood glucose fluctuation and cesarean section rate.