基于生存分析法的胰岛素使用方式对妊娠糖尿病围术期的影响

Effect of Insulin Based on Survival Analysis on Perioperative Gestational Diabetes Mellitus

目的探讨皮下注射、持续胰岛素泵及联合应用对妊娠糖尿病(GDM)围术期的影响,为有效、安全使用胰岛素提供依据。方法抽取2012年5月-2015年1月行剖宫产的GDM 120例作为研究对象,根据胰岛素使用方法分为A组(皮下注射)35例、B组(单纯持续胰岛素泵注射)42例、C组(持续胰岛素泵联合皮下注射)43例。使用生存分析法分析3种胰岛素注射方法对血糖水平、胰岛素用量、手术时间、手术出血量、低血糖反应、切口愈合、住院时间、新生儿不良结局的影响。结果 C组血糖水平、胰岛素用量、低血糖反应发生率、住院时间均低于A组和B组,切口愈合优于A、B组(P<0.05);3组新生儿不良结局、手术时间、手术出血量差异无统计学意义(P>0.05);生存分析结果显示,C组和B组空腹血糖控制效果明显优于A组,C组餐后2 h血糖、胰岛素用量低于A、B组,住院天数少于A、B组。结论持续胰岛素泵联合皮下注射对GDM围术期效果优于单纯胰岛素泵及皮下注射,且可减少胰岛素用量、降低低血糖反应发生率。

Objective To evaluate the role of intermittent subcutaneous insulin injection,continuous subcutaneous injection,and insulin pumps in the treatment of perioperative gestational diabetes mellitus( GDM) in order to ensure effective and safe use of insulin. Methods A total of 120 GDM patients undergoing cesarean section between May 2012 and January 2015 were randomly selected as subjects. According to use methods of insulin,35 cases were regarded as group A( subcutaneous injection),42 cases as group B( pure continuous insulin pump injection),43 as group C( continuous subcutaneous injection combined with the insulin pump). Survival analysis was used to study the effect of the three methods of insulin injection on blood glucose,insulin dosage,operation time,blood loss,low blood glucose reaction,incision healing,hospital stay,and neonatal adverse outcomes. Results The results showed that continuous subcutaneous injection combined with an insulin pump decreased blood glucose levels,insulin dosage,incidence of hypoglycemia and length of hospital stay,these indexes were all lower than those of group A and group B,and that incision healing was better than that of group A and B( P<0.05). There was no statistically significant difference in the neonatal adverse outcome,operation time and surgical blood loss between the three groups( P>0.05). Survival analysis showed that the fasting blood glucose was better controlled in group C and group B than in group A,and that blood glucose after a meal,insulin dosage,and hospital stay in group C were lower or shorter than in group A and group B.Conclusion The combination of continuous insulin pumps with subcutaneous injection is a more effective treatment of perioperative GDM than theinsulin pump alone or subcutaneous injection of insulin,for it can reduce the dosage of insulin and blood glucose reactions.