观察不同时期加用胰岛素治疗妊娠合并糖尿病孕产妇对血糖控制的效果及妊娠结局的影响

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[摘要] 目的 研究觀察不同时期加用胰岛素治疗妊娠合并糖尿病孕产妇对血糖控制的效果及妊娠结局的分析。方法 纳入该院从2018年3月—2019年3月期间收治40例妊娠合并糖尿病孕妇择为研究对象，分为对照组和观察组，妊娠32周之后使用胰岛素治疗的患者为对照组，妊娠32周之前使用胰岛素治疗的患者为观察组，评估患者个人状况，为患者的制定科学的胰岛素使用剂量，对比两组患者的空腹血糖水平以及妊娠结局。结果 治疗后，两组的各项血糖水平相关指标数值与治疗前相比均有所降低，且观察组的空腹血糖、餐后2 h血糖、24 h平均血糖波动幅度和日间平均血糖波动幅度的具体数值均明显低于对照组，差异有统计学意义（P<0.05）。治疗后，观察组的剖宫产、妊高症、早产和产后出血的发生率均明显低于对照组（P<0.05）。两组新生儿的巨大儿、窒息和高胆红素血症的发生率相比差异无统计学意义（P>0.05），观察组新生儿的低血糖发生率低于对照组新生儿（P<0.05）。结论 妊娠合并糖尿病孕妇的孕期32周前即为其开展胰岛素治疗的血糖控制效果较为理想，可有效控制孕妇的血糖波动情况，并明显降低新生儿低血糖的发生率。

[关键词] 胰岛素治疗;妊娠合并糖尿病;妊娠结局

[中图分类号] R587.1          [文献标识码] A          [文章编号] 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.