妊娠合并糖尿病孕产妇不同时期加用胰岛素治疗对妊娠结局临床效果评价

Evaluation of Clinical Outcomes of Pregnant Women with Diabetes Mellitus Combined with Insulin at Different Periods on Pregnancy Outcomes

目的就不同时期为妊娠合并糖尿病孕产妇加用胰岛素治疗对其妊娠结局所产生的具体影响展开分析与探讨。方法选择在该院接受治疗的妊娠合并糖尿病孕产妇100例纳入该次研究,病例选取时间范围为2017年1月—2019年1月,以孕产妇接受胰岛素治疗时期的不同为依据将其分为两组,其中A组中共包含孕产妇43例,在孕32周后接受胰岛素治疗,B组中共包含孕产妇57例,在孕32周前接受胰岛素治疗,对两组孕产妇治疗前后的血糖水平、妊娠结局及新生儿并发症发生情况展开观察。结果治疗后,B组孕产妇的空腹血糖水平与餐后2h血糖水平分别为(5.18±1.16)mmol/L、(7.08±1.34)mmol/L,明显较A组孕产妇的(5.97±1.28)mmol/L、(7.99±1.46)mmol/L低(t=2.045,P=0.048、t=2.054,P=0.047);B组孕产妇的早产、剖宫产、妊娠合并高血压、产后出血、感染率分别为8.77%(5/57)、12.28%(7/57)、7.02%(4/57)、1.75%(1/57),明显低于A组孕产妇的27.91%(12/43)、44.19%(19/43)、20.93%(9/43)、11.63%(5/43)(χ^2=6.360,P=0.012、χ^2=12.968,P=0.000、χ^2=4.195,P=0.041、χ^2=4.237,P=0.040);B组新生儿低血糖、新生儿窒息、低体重儿、巨大儿的发生率分别为1.75%(1/57)、1.75%(1/57)、3.51%(2/57)、7.02%(4/57),较A组的11.63%(5/43)、13.95%(6/43)、12.28%(7/43)、41.86%(18/43)明显更低(χ^2=4.237,P=0.040、χ^2=5.603,P=0.018、χ^2=4.881,P=0.027、χ^2=17.340,P=0.000)。结论在妊娠合并糖尿病孕产妇孕32周前为其实施胰岛素治疗能使之血糖水平得到更好控制,改善其妊娠结局,并降低其腹中胎儿所面临的新生儿并发症发生风险。

Objective The specific effects of insulin therapy on pregnancy outcomes of pregnant women with gestational diabetes mellitus in different periods were analyzed and discussed.Methods Selection in the hospital treated 100 cases of pregnancy with diabetes maternal in this study,cases selected time range is between January 2017 and January 2019,with maternal accept on the basis of the different period of insulin treatment to be divided into two groups,group A were contains maternal 43 cases,insulin therapy after 32 weeks gestation,group B contains maternal 57 cases,receiving insulin therapy in before 32 weeks,on two groups of maternal blood glucose level before and after the treatment,to observe the pregnancy outcome and neonatal complications.Results After treatment,fasting blood glucose level and postprandial blood glucose level of pregnant women in group B were(5.18±1.16)mmol/L and(7.08±1.34)mmol/L,respectively,which were significantly lower than those in group A(5.97±1.28)mmol/L and(7.99±1.46)mmol/L(t=2.045,P=0.048,t=2.054,P=0.047).The preterm delivery,cesarean section,pregnancy complicated with hypertension,postpartum hemorrhage and infection rate in group B were 8.77%(5/57),12.28%(7/57),7.02%(4/57),and 1.75%(1/57),respectively,which were significantly lower than those in group A(27.91%(12/43),44.19%(19/43),20.93%(9/43),and 11.63%(5/43)(χ^2=6.360,P=0.012,χ^2=12.968,P=0.000,χ^2=4.195,P=0.041,χ^2=4.236,P=0.000);the incidence of hypoglycemia,neonatal asphyxia,low birth weight and macrosomia in group B was 1.75%(1/57),1.75%(1/57),3.51%(2/57)and 7.02%(4/57),respectively,which were significantly lower than those in group A 11.63%(5/43),13.95%(6/43),12.28%(7/43)and 41.86%(18/43)(χ^2=4.236,P=0.040,χ^2=5.603,P=0.018,χ^2=4.880,P=0.027,χ^2=17.340,P=0.000).Conclusion Insulin therapy for pregnant women with diabetes mellitus 32 weeks before pregnancy can control their blood sugar level better,improve their pregnancy outcomes,and reduce the risk of neonatal complications faced by their abdominal fetuses.