觀察不同時期加用胰島素治療妊娠合并糖尿病孕產婦對血糖控制的效果及妊娠結局的影響

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[摘要] 目的 研究觀察不同時期加用胰島素治療妊娠合并糖尿病孕產婦對血糖控制的效果及妊娠結局的分析。方法 納入該院從2018年3月—2019年3月期間收治40例妊娠合并糖尿病孕婦擇為研究對象，分為對照組和觀察組，妊娠32周之后使用胰島素治療的患者為對照組，妊娠32周之前使用胰島素治療的患者為觀察組，評估患者個人狀況，為患者的制定科學的胰島素使用劑量，對比兩組患者的空腹血糖水平以及妊娠結局。結果 治療后，兩組的各項血糖水平相關指標數值與治療前相比均有所降低，且觀察組的空腹血糖、餐后2 h血糖、24 h平均血糖波動幅度和日間平均血糖波動幅度的具體數值均明顯低于對照組，差異有統計學意義（P<0.05）。治療后，觀察組的剖宮產、妊高癥、早產和產后出血的發生率均明顯低于對照組（P<0.05）。兩組新生兒的巨大兒、窒息和高膽紅素血癥的發生率相比差異無統計學意義（P>0.05），觀察組新生兒的低血糖發生率低于對照組新生兒（P<0.05）。結論 妊娠合并糖尿病孕婦的孕期32周前即為其開展胰島素治療的血糖控制效果較為理想，可有效控制孕婦的血糖波動情況，并明顯降低新生兒低血糖的發生率。

[關鍵詞] 胰島素治療;妊娠合并糖尿病;妊娠結局

[中圖分類號] R587.1 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1672-4062（2020）06（a）-0041-03

[Abstract] Objective To study the effect of adding insulin to pregnant women with diabetes mellitus at different periods on blood glucose control and pregnancy outcome analysis. Methods 40 pregnant women with diabetes mellitus who were admitted to the hospital from March 2018 to March 2019 were selected as the research object， and were divided into a control group and an observation group. Patients treated with insulin after 32 weeks of pregnancy were the control group. The patients treated with insulin before 32 weeks of pregnancy were the observation group， to evaluate the patients' personal conditions， formulate scientific insulin dosage for the patients， and compare the fasting blood glucose levels and pregnancy outcomes of the two groups of patients. Results After treatment， the values of various blood glucose levels in the two groups were reduced compared with those before treatment， and the fasting blood glucose， 2 h postprandial blood glucose， 24 h average blood glucose fluctuations and daytime average blood glucose fluctuations in the observation group were specific. The values were significantly lower than the control group， the difference was statistically significant（P<0.05）. After treatment， the incidence of cesarean section， pregnancy-induced hypertension， premature delivery， and postpartum hemorrhage in the observation group were significantly lower than those in the control group（P<0.05）. There was no statistically significant difference in the incidence of macrosomia， asphyxia and hyperbilirubinemia between the two groups of neonates（P>0.05）. The incidence of hypoglycemia in the observation group was lower than that in the control group（P<0.05）. Conclusion The pregnant women with diabetes mellitus had the ideal effect of glycemic control for insulin therapy 32 weeks before pregnancy， which can effectively control the blood glucose fluctuations of pregnant women and significantly reduce the incidence of neonatal hypoglycemia.