不同时期加用胰岛素对妊娠合并糖尿病孕产妇妊娠结局的影响

Effect of insulin in different periods on pregnancy outcome in pregnant and parturient with pregnancy combined with diabetes

目的探讨不同时期加用胰岛素对妊娠合并糖尿病孕产妇妊娠结局的影响。方法 150例妊娠合并糖尿病孕产妇,按照胰岛素不同给药时间分为前期组(孕<32周,80例)和后期组(孕≥32周,70例);胰岛素服用方法和计量按照孕产妇个体情况而定;对两组血糖、妊娠并发症及新生儿并发症进行统计分析。结果治疗后,前期组孕产妇空腹血糖和餐后2 h血糖分别为(5.31±0.61)、(7.16±0.84)mmol/L,显著优于后期组的(5.82±0.52)、(7.77±0.91)mmol/L,差异有统计学意义(P<0.05)。治疗后,前期组合并高血压、死产、产后出血及感染发生率均显著低于后期组,剖宫产及早产发生率均显著高于后期组,前期组各新生儿并发症发生率均显著低于后期组,差异有统计学意义(P<0.05)。结论在孕32周前对妊娠合并糖尿病孕妇进行治疗可显著控制孕产妇血糖,同时可显著改善妊娠并发症及新生儿并发症的发生情况;对妊娠合并糖尿病孕产妇应做到早发现,早治疗。

Objective To discuss the effect of insulin in different periods on pregnancy outcome in pregnant and parturient with pregnancy combined with diabetes.Methods A total of 150 pregnant and parturient with pregnancy combined with diabetes were divided by different administration time of insulin into pre-stage group（32 weeks gestation,80 cases） and post-stage group（32 weeks gestation,70 cases）.Insulin administration and measurement according to the individual situation of pregnant and parturient.Analysis were made on blood glucose,pregnancy complications and neonatal complications between the two groups.Results After treatment,pre-stage group had obviously better fasting blood glucose and postprandial 2 h blood glucose respectively as（5.31±0.61） and（7.16±0.84） mmol/L than（5.82±0.52） and（7.77±0.91） mmol/L in post-stage group,and their difference was statistically significant（P〈0.05）.After treatment,pre-stage group had lower incidence of hypertension,stillbirth,postpartum hemorrhage and infection than post-stage group,and higher incidence of cesarean section and premature delivery than post-stage group,and obviously lower incidence of neonatal complications than post-stage group,and their difference was statistically significant（P〈0.05）.Conclusion Treatment before 32 weeks gestation for pregnant and parturient with pregnancy complicated with diabetes,can significantly control the blood glucose of pregnant women,and significantly improve the incidence of complications and neonatal complications.Early pregnancy and early treatment should be done for pregnant and parturient with pregnancy complicated with diabetes.