门冬胰岛素泵注治疗妊娠期糖尿病61例临床观察

Clinical Observation on Insulin Pump with Insulin Aspart Injection in the Treatment of Gestational Diabetes Mellitus in 61 Cases

目的比较胰岛素泵泵注门冬胰岛素(诺和锐)与皮下注射重组人胰岛素预混(诺和灵30R)对妊娠期糖尿病(GDM)孕妇的降糖效果及对妊娠结局的影响。方法选取医院2015年7月至2016年12月收治的GDM孕妇143例,其中61例(A组)采用胰岛素泵注诺和锐降血糖,82例(B组)采用皮下注射诺和灵30R降糖。结果 A组患者血糖达标时间显著短于B组[(5.43±1.82)d比(6.79±2.09)d,P<0.05],达标时A组日胰岛素总量少于B组[(45.95±13.55)U比(49.14±10.23)U,P>0.05];A组治疗4周后早餐后2 h PG[(6.32±1.01)mmol/L比(6.86±1.15)mmol/L,P<0.05],糖化血红蛋白(Hb A1 C)显著低于B组[(6.15±0.75)%比(6.52±0.93)%,P<0.05];两组羊水过多发生率(9.84%比10.98%)、胎膜早破发生率(8.20%比8.54%)、子痫前期发生率(9.84%比13.41%)、早产发生率(9.84%比10.98%)、巨大儿发生率(3.28%比6.10%)、新生儿低血糖发生率(8.20%比10.98%)、出生1 min Apgar评分≤7分比例(6.56%比8.54%)比较,差异均无统计学意义(P>0.05);A组低血糖事件及胃肠道功能紊乱发生率均低于B组(11.48%比19.51%,8.20%比14.63%),但差异均无统计学意义(P>0.05)。结论治疗GDM,胰岛素泵泵注诺和锐较皮下注射诺和灵30R血糖达标时间更短,餐后血糖控制更优,低血糖事件发生率更低。

Objective To compare the clinical efficacy between Insulin Aspart Injection（ NovoRapid） by insulin pump and Isophane Protamine Biosynthetic Human Insulin Injection（ pre-mixed 30 R,Novolin 30 R） by subcutaneous injection in the treatment of gestational diabetes mellitus（ GDM） and its effect on pregnancy outcome. Methods Totally 143 pregnant women with GDM admitted to our hospital from July 2015 to December 2016 were selected,the group A（ 61 cases） was given NovoRapid by insulin pump,while the group B（ 82 cases） was given Novolin 30R by subcutaneous injection. Results The time of reaching glucose control in group A was significantly shorter than that in group B [（ 5. 43 ± 1. 82） d vs.（ 6. 79 ± 2. 09） d,P 〈 0. 05 ],and the total amount of insulin of group A was less than that of group B at the control time [（ 45. 95 ± 13. 55） U vs.（ 49. 14 ± 10. 23） U,P 〉 0. 05 ]. After 4 weeks of treatment,the 2 h PG after breakfast in group A was significantly lower than that of group B [（ 6. 32 ± 1. 01） mmol/L vs.（ 6. 86 ± 1. 15） mmol/L,P 〈 0. 05 ],the HbA1C in group A was significantly lower than that of group B [（ 6. 15 ± 0. 75） % vs.（ 6. 52 ± 0. 93） %,P 〈 0. 05 ]. The incidence rates of hydramnios（ 9. 84% vs. 10. 98%）,membranes premature rupture（ 8. 20% vs. 8. 54%）,preeclampsia（ 9. 84% vs. 13. 41%）,premature birth（ 9. 84% vs. 10. 98%）,macro-somia（ 3. 28% vs. 6. 10%）,neonatal hypoglycemia（ 8. 20% vs. 10. 98%） and ratio of 1 min Apgar score≤7（ 6. 56% vs. 8. 54%） in the two groups had no statistical significance（ P 〉 0. 05）. The incidence rates of hypoglycemia and gastrointestinal dysfunction in group A were lower than those in group B（ 11. 48% vs. 19. 51%,8. 20% vs. 14. 63%）,but the differences with no statistical significance（ P 〉 0. 05）. Conclusion Compared with Novolin 30R by subcutaneous injection,NovoRapid by insulin pump in treatment of GDM is more effective in reaching the blood glucose control time,and with advantageous in postprandial blood glucose control and lower incidence rate of hypoglycemia.