胰岛素泵持续皮下注射改善妊娠期糖尿病患者血糖水平及母儿结局的临床研究

Effect of Continuous Subcutaneous Injection of Insulin Pump on Blood Glucose Level and Maternal and Fetal Outcomes in Patients with Gestational Diabetes Mellitus

目的 观察胰岛素泵持续皮下注射(CSⅡ)改善妊娠期糖尿病(GDM)患者血糖水平及母儿结局的临床效果。方法 将我院2018年12月至2019年10月收治的128例GDM患者随机分为试验组(n=66)和对照组(n=62),试验组给予CSⅡ治疗,对照组给予胰岛素多次皮下注射(MSⅡ)治疗,观察治疗前及治疗1个月后两组孕妇脂联素、内脂素和胰岛素抵抗(IR)水平变化情况,比较两组孕妇血糖水平控制情况、剖宫产率及并发症发生情况和胎儿不良妊娠结局发生情况差异。结果 试验组孕妇治疗1个月后FPG、1h PG、2h PG、血糖达标时间、胰岛素用量及28、34周HbA1c水平低于对照组,但均无明显差异(P>0.05);治疗1个月后,两组孕妇脂联素水平均较治疗前显著升高,内脂素及IR水平均较治疗前显著降低,且组间比较有显著差异(P<0.05);试验组孕妇剖宫产率、并发症总发生率及胎儿不良妊娠结局总发生率低于对照组,但均无明显差异(均P>0.05)。结论 CSⅡ和MSⅡ应用于GDM治疗均可有效控制孕妇血糖水平,其中,CSⅡ疗法对血清脂联素、内脂素及IR水平改善作用更佳,且相较于MSⅡ治疗更利于降低母婴不良妊娠结局及并发症发生风险,具有较高应用价值。

Objective to observe the clinical effect of continuous subcutaneous insulin infusion(CSⅡ) on improving blood glucose level and maternal and fetal outcomes in patients with gestational diabetes Mellitus(GDM). Methods A total of 128 patients with GDM admitted from December 2018 to October 2019 were randomly divided into two groups: the Experimental Group(N = 66) and the Control Group(N = 62). The experimental group was treated with CSⅡ and the control group was treated with multiple subcutaneous insulin injection(MSⅡ). The levels of adiponectin,visfatin and insulin resistance(Ir) were measured before treatment and 1 month after treatment, and the control of blood glucose level, the rate of cesarean section, the incidence of complications and the incidence of adverse pregnancy outcomes were compared between the two groups. Results After 1 month treatment, FPG, 1h PG, 2h PG, blood glucose reaching standard time, insulin dosage and HbA1c level of pregnant women in the test group were lower than those in the control group, but there was no significant difference(P>0.05). The levels of adiponectin,visfatin and IR in the two groups were significantly lower than those before treatment, and there was significant difference between the two groups(P<0.05). The rate of cesarean section, the total incidence of complications and the total incidence of adverse pregnancy outcome in the test group were lower than those in the control group, but there was no significant difference(P>0.05). Conclusion CSⅡ and MSⅡ in treatment of GDM can effectively control the blood glucose level of pregnant women, among which CSⅡ can improve the serum adiponectin, visfatin and IR levels better, and compared with MSⅡ treatment, MSⅡ treatment is more beneficial to reduce the risk of adverse pregnancy outcomes and complications, and has higher application value.