延迟不同时间结扎脐带对妊娠糖尿病母亲新生儿血糖、胰岛素的影响

Effect of Different Timing of Umbilical Cord Clamping on Levels of Glucose,Insulin for the Newborns with Gestational Diabetes Mellitus

目的:探讨延迟不同时间结扎脐带对妊娠糖尿病母亲新生儿血糖、胰岛素的影响。方法:216例妊娠糖尿病产妇随机分为A组(早结扎脐带组30s以内)、B组(延迟结扎脐带60s组)、C组(延迟结扎脐带180s组),各组分别对脐带血、生后2h以内、48h后静脉血血糖、胰岛素进行检测;采用SPSS21.0进行数据分析。结果:(1)B、C组新生儿生后2h内静脉血糖较A组高,差异有统计学意义(P=0.00);B、C组新生儿生后48h以后静脉血糖较A组高,差异有统计学意义(P=0.00)。(2)B、C组新生儿生后2h内低血糖发生率较A组低,差异有统计学意义(P=0.018);B、C组新生儿生后48h以后低血糖发生率较A组低,差异有统计学意义(P=0.015)。(3)A、B、C三组新生儿生后2h内和生后48h以后静脉血胰岛素差异无统计学意义(P=0.983、0.929)。(4)A、B、C三组的新生儿生后2h;生后48h后高胰岛素血症发生率差异无统计学意义(P=0.986)。结论:延迟脐带结扎60s、180s能够提高IGDMS血糖水平,尤其是60s组优于早结扎和180s组,没有增加高胰岛素血症,显著降低低血糖的发生率,有利于减少低血糖脑损伤发生,有利于新生儿期的发育,值得临床推广应用。

Objective:To study the effect of delayed umbilical cord clamping on levels of glucose,insulin for newborns with gestational diabetes mellitus.Methods:216 cases of mothers with gestational diabetes mellitus were randomized to 3 groups.In group A,the infants had immediately umbilical code clamped within 30 seconds after birth.In group B,the infant had umbilical code clamped delayed by 60 seconds after birth.In group C,the infant had umbilical code clamped delayed by 180 seconds after birth.In each group,levels of glucose,insulin in both umbilical cord blood and venous blood taken from infants within 2 hours and after 48 hours of birth were measured.All datas were analyzed by SPSS21.0.Results:(1)The glucose level of infants within 2 hours from birth for group B and C were higher than group A(P=0.00).The glucose level of infants after 48 hours from birth for group B and C were higher than group A(P=0.00).(2)The hypoglycemia occurrence rate of infants within 2 hours from birth for group B and group C were lower than group A(P=0.018).The hypoglycemia occurrence rate of infants after 48 hours from birth for group B and group C were lower than group A(P=0.015).(3)The insulin level of infants within 2 hours and after 48 hours from birth for group A,group B and group C were no differences(P>0.05).(4)The hyperinsulinemia occurrence rate of infants within 2 hours and after 48 hours from birth for group B and group C were no differences than group A(P>0.05).Conclusion:The blood glucose in neonates of gestational diabetes mellitus with delayed umbilicai cord ligation for 60 s and 180 s was more higher than that of neonates with immediately umbilical code clamped.The hyperinsulinemia occurrence rate of infants was not increased.It can not only reduce the incidence of hypoglycemia but also reduce hypoglycemia brain damage,which is beneficial to neonates of gestational diabetes mellitus develepment.