二甲双胍联合门冬胰岛素治疗妊娠期糖尿病患者的疗效及对妊娠结局和新生儿的影响

Efficacy of Metformin combined with insulin Aspart in the treatment of gestational diabetes and its effect on pregnancy outcomes and Newborn

目的探讨二甲双胍联合门冬胰岛素治疗妊娠期糖尿病(GDM)患者的疗效及对妊娠结局和新生儿的影响。方法选取2014年1月~2017年8月妇产科门诊就诊确诊并拟在我院分娩的GDM患者140例,随机分为观察组和对照组。两组孕妇均予以健康教育、饮食控制及运动干预等基础治疗。对照组孕妇在此基础上加用门冬胰岛素治疗,在晚餐前于皮下注射,开始剂量为0.25 IU/(kg·d),后根据血糖水平增减2 IU。观察组在对照组基础上加用二甲双胍治疗,开始剂量0.5 g/次,2次/d,逐渐加量至2500 mg/d,两组孕妇均使用至妊娠结束。观察并比较两组孕妇治疗至分娩时的血糖控制及妊娠结局和对新生儿的影响。结果治疗至分娩时,两组孕妇FBG、2 hPG和HbA1C水平较前明显下降(P<0.05或P<0.01),且观察组孕妇较对照组下降幅度更明显(P<0.05)。观察组孕妇的剖宫产、子痫前期、蛋白尿、早产和胎膜早破的发生率低于对照组(P<0.05);观察组新生儿窒息、低血糖、黄疸、呼吸窘迫和巨大儿的发生率低于对照组(P<0.05)。结论二甲双胍联合门冬胰岛素治疗GDM孕妇的疗效确切,能明显改善糖代谢指标,能降低母婴不良妊娠结局。

Objective To investigate the efficacy of metformin combined with insulin aspart in the treatment of gestational diabetes mellitus （GDM） and its effect on pregnancy outcomes and newborn. Methods 140 patients with GDM who were diagnosed in the outpatient clinic of gynecology and obstetrics in our hospital from January 2014 to August 2017 were selected. They were randomly divided into observation group and control group. Both groups of pregnant women were given basic treatment such as health education, diet control and exercise intervention. The pregnant women in the control group were given insulin aspart on this basis. It was injected subcutaneously before dinner, with the starting dose of 0.25 IU/（kg·d）. The dose was increased or decreased for 2 IU according to blood glucose level. The observation group was given metformin on the basis of the control group, with the starting dose of 0.5 g/time, twice a day. The dose was gradually increased to the amount of 2500 mg/d. Both groups of pregnant women were given the dose until the end of pregnancy. The blood glucose control and maternal and neonatal adverse pregnancy outcomes and impact on newborn were observed and compared between the two groups of pregnant women from treatment to deliv- ery. Results From the time of treatment to delivery, the levels of FBG, 2 hPG, and HbA1C in the two groups of pregnant women were significantly lower than before （P〈0.05 or P〈0.01）. The decrease in the pregnant women in the observation group was more significant than that in the control group （P〈0.05）. The incidence rate of cesarean section, preeclampsia, proteinuria, premature delivery and premature rupture of membranes was lower in the observation group than in the control group （P〈0.05）; the incidence rate of neonatal asphyxia, hypoglycemia, jaundice, respiratory distress, and macrosomia was lower in the observation group than in the control group （P〈0.05）. Conclusion Metformin combined with insulin aspart in the treatment of GDM pregnant women is effective, which can significantly improve the glucose metabolism indicators, and can reduce maternal and neonatal adverse pregnancy outcomes.