孕32周前和32周后使用胰岛素治疗妊娠期糖尿病的临床效果

Clinical Effect of Insulin Therapy on Gestational Diabetes before and after 32 Weeks of Pregnancy

目的探讨孕32周前和32周后使用胰岛素治疗妊娠期糖尿病的效果差异。方法将2019年6月至2022年3月新郑华信民生医院产科收治的90例妊娠期糖尿病患者进行分组研究。采用随机数字表法将患者分为观察组和对照组,每组各45例。对照组在孕32周后使用胰岛素,观察组在孕32周及以前使用胰岛素,比较两组的血糖控制效果、妊娠结局及不良反应发生率。结果两组治疗前空腹血糖(FPG)、餐后2h血糖(2hPG)、胰岛素抵抗指数(HOMA-IR)水平差异无统计学意义(P>0.05),观察组分娩前24h三项指标均低于对照组,差异有统计学意义(P<0.05)。观察组的分娩孕周大于对照组,剖宫产、产后出血等不良妊娠事件均低于对照组,差异有统计学意义(P<0.05)。观察组巨大儿、新生儿窒息、新生儿低血糖、新生儿高胆红素血症均低于对照组,其中巨大儿、新生儿窒息差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论孕32周前使用胰岛素治疗妊娠期糖尿病可取得更理想的血糖控制效果,进而降低不良妊娠事件的发生。

Objectice To investigate the effect of insulin on diabetes in pregnancy before and after 32 weeks of pregnancy.Methods From June 2019 to March 2022,90 patients with gestational diabetes who were admitted to Xinzheng Huaxin Minsheng Hospital for obstetrics were grouped and studied.The patients were divided into an observation group and a control group using a random number table method,with 45 cases in each group.The control group received insulin after 32 weeks of pregnancy,while the observation group received insulin before and after 32 weeks of pregnancy.The blood glucose control effect,pregnancy outcome,and incidence of adverse reactions were compared between the two groups.Results There was no statistically significant difference in the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and insulin resistance index(HOMA-IR)between the two groups before treatment(P>0.05).The observation group had lower levels of three indicators 24 hours before delivery than the control group,and the difference was statistically significant(P<0.05).The gestational weeks of delivery in the observation group were greater than those in the control group,and adverse pregnancy events such as cesarean section and postpartum hemorrhage were lower than those in the control group,with statistical significance(P<0.05).The macrosomia,neonatal asphyxia,neonatal hypoglycemia and neonatal hyperbilirubinemia in the observation group were lower than those in the control group,and the difference between macrosomia and neonatal asphyxia was statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Using insulin to treat gestational diabetes before 32 weeks of pregnancy can achieve better blood glucose control effect,thereby reducing the incidence of adverse pregnancy events.