胰島素治療妊娠糖尿病起始劑量與妊娠結局的相關性分析

徐丹芬　趙卓姝　溫倩敏

[摘要] 目的 探討與分析胰島素治療妊娠糖尿病的起始劑量與妊娠結局的相關性。方法 2015年5月—2018年12月選擇診治的106例妊娠糖尿病孕婦，根據隨機數字表法分為低劑量組與高劑量組各53例。高劑量組：給予胰島素1日多次給藥治療，門冬胰島素注射液初始劑量0.5 U/（kg·d），低劑量組給予胰島素泵持續治療，門冬胰島素注射液起始劑量0.2 U/（kg·d），兩組療程均為4周，記錄兩組妊娠結局。結果 低劑量組的胰島素用量顯著低于高劑量組（P<0.05），兩組血糖達標時間對比差異無統計學意義（P>0.05）。兩組治療后的FPG與2 hPG值都顯著低于治療前（P<0.05）。所有孕婦都順利完成分娩，低劑量組的羊水過多、早產、妊娠期高血壓、低血糖等并發癥發生率為3.8%，顯著低于高劑量組的24.5%（P<0.05）。低劑量組的新生兒高膽紅素血癥、新生兒低血糖、新生兒窒息、巨大兒等并發癥發生率為3.8%，顯著低于高劑量組的26.4%（P<0.05）。結論 基于初始低劑量的胰島素泵注射方式在妊娠糖尿病孕婦中的應用能減少胰島素的應用劑量，能達到同樣的降糖效果，改善孕婦與新生兒的預后。

[關鍵詞] 初始劑量;胰島素泵;妊娠糖尿病;妊娠結局

[中圖分類號] R714.256? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1672-4062（2020）02（a）-0072-04

Correlation Analysis Between the Initial Dose of Insulin Treatment for Gestational Diabetes and Pregnancy Outcome

XU Dan-fen， ZHAO Zhuo-shu， WEN Qian-min

Department of Obstetrics and Gynecology， Shunde Women's and Children's Hospital of Guangdong Medical University（Foshan Shunde District Maternal and Child Health Hospital）， Foshan， Guangdong Province， 528300 China

[Abstract] Objective To explore and analyze the correlation between the initial dose of insulin for gestational diabetes and pregnancy outcome. Methods From May 2015 to December 2018， 106 pregnant women with gestational diabetes were selected for diagnosis and treatment. They were divided into low-dose group and high-dose group with 53 cases according to the random number table method. High-dose group： Insulin was administered multiple times a day. The initial dose of insulin aspart was 0.5 U/（kg·d）. The low-dose group was given continuous treatment with an insulin pump. The initial dose of insulin aspart was 0.2 U/（kg·d）， the treatment course of both groups was 4 weeks， and the pregnancy outcomes of the two groups were recorded. Results The dosage of insulin in the low-dose group was significantly lower than that in the high-dose group（P<0.05）， and there was no significant difference in blood glucose compliance time between the two groups（P>0.05）. The FPG and 2 hPG values after treatment in both groups were lower before treatment（P<0.05）. All pregnant women completed delivery successfully. The incidence of complications such as polyhydramnios， premature delivery， hypertension during pregnancy， and hypoglycemia in the low-dose group was 3.8%， which was significantly lower than 24.5% in the high-dose group（P<0.05）. The complication rate of neonatal hyperbilirubinemia， neonatal hypoglycemia， neonatal asphyxia， and giant infants in the low-dose group was 3.8%， which was significantly lower than 26.4% in the high-dose group（P<0.05）. Conclusion The application of the initial low-dose insulin pump injection method in pregnant women with gestational diabetes can reduce the dosage of insulin， achieve the same effect of lowering glucose， and improve the prognosis of pregnant women and newborns.

妊娠糖尿病是妊娠期合并癥之一，屬于高危妊娠，與多種不良妊娠結局相關，還可能長期影響胎兒神經系統及精神發育，早期有效控制血糖水平被認為是治療妊娠糖尿病與改善孕婦、圍產兒預后的關鍵[17-18]。外源性胰島素可有效降低妊娠糖尿病孕婦血糖水平，最大程度模擬胰島素生理性分泌模式，從而降低圍生期母嬰不良結局發生風險[19-20]。特別是通過微量輸注胰島素的方式，可有效降低孕婦低血糖發生風險，避免夜間血糖異常波動[21-22]。該研究顯示所有孕婦都順利完成分娩，低劑量組的羊水過多、早產、妊娠期高血壓、低血糖等并發癥發生率為3.8%，顯著低于高劑量組的24.5%（P<0.05）;低劑量組的新生兒高膽紅素血癥、新生兒低血糖、新生兒窒息、巨大兒等并發癥發生率為3.8%，顯著低于高劑量組的26.4%（P<0.05）。表明胰島素泵注射治療能改善孕婦與新生兒的預后。并且胰島素泵具有操作簡單、攜帶方便等優勢，能夠更靈活地設定不同時段輸注參數，也可通過小劑量追加胰島素等方式降低治療成本[23-25]。不過該次研究樣本量較少，隨訪時間比較短，且機制分析不夠深入，在今后的研究中將進行重點分析。

綜上所述，基于初始低劑量的胰島素泵注射方式在妊娠糖尿病孕婦中的應用能減少胰島素的應用劑量，能達到同樣的降糖效果，能改善孕婦與新生兒的預后。……