不同孕周给予胰岛素治疗妊娠期糖尿病的临床观察
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篇名: 不同孕周给予胰岛素治疗妊娠期糖尿病的临床观察
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目的:观察不同孕周给予胰岛素治疗妊娠期糖尿病的疗效和安全性。方法:回顾性收集121例妊娠期糖尿病患者资料,按首次使用胰岛素的不同孕周分为观察组(63例)和对照组(58例)。两组患者均给予饮食控制[(热量控制在30~35 kJ/(kg·d), 碳水化合物55%, 脂肪25%,蛋白质20%)]。在此基础上,观察组患者根据空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平于<孕30周给予生物合成人胰岛素注射液,按4 ∶ 2 ∶ 3 ∶ 1的比例以4~6单位分别于三餐前及睡前注射,治疗期间监测患者的血糖情况,防止低血糖等并发症的发生。对照组患者于≥孕30周时给予生物合成人胰岛素注射液(用法用量同对照组)。两组疗程均为15 d。观察两组患者初诊时、分娩时的FPG、2 h PG水平,妊娠结局及新生儿情况,并记录不良反应发生情况。结果:初诊时,两组患者FPG、2 h PG水平比较,差异均无统计学意义(P>0.05)。分娩时,两组患者FPG、2 h PG水平均显著低于同组初诊时,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者早产、妊娠期高血压、新生儿窒息、低体质量儿、新生儿低血糖发生率均显著低于对照组,新生儿Apgar评分显著高于对照组,差异均有统计学意义(P<0.05);两组患者羊水过多、剖宫产、巨大儿发生率比较,差异均无统计学意义(P>0.05)。两组患者用药期间均未见明显不良反应发生。结论:在控制饮食的基础上,孕30周前给予胰岛素治疗妊娠期糖尿病,可有效控制血糖水平,改善妊娠结局,且安全性较好。

关键词 胰岛素;妊娠期糖尿病;不同孕周;疗效;安全性

ABSTRACT: OBJECTIVE: To observe the efficacy and safety of insulin in the treatment of gestational diabetes in different gestational age. METHODS: The data of 121 women with gestational diabetes were retrospectively analyzed, and divided into observation group (63 cases) and control group (58 cases) based on first use of insulin in different gestational age. All patients received dirt control [(calorie control in 30-35 kJ/(kg·d), 55% carbohydrates, 25% fat and 20% protein)]; based on it, Biosynthetic human insulin injection was injected before meals and at bedtime by 4 ∶ 2 ∶ 3 ∶ 1 with 4-6 units before pregnant 30 weeks according to the FPG and postprandial 2 h blood glucose (2 h PG) levels in observation group, the blood glucose of women with gestational diabetes was monitored to prevent the occurrence of complications such as hypoglycemia. Control group received Biosynthetic human insulin injection (the same dosage with control group) when no less than 30 weeks. The treatment course for both groups was 15 d. FPG and 2 h PG levels when first diagnosed and delivery, pregnancy outcomes and neonatal conditions in 2 groups were observed, and the incidence of adverse reactions was recorded. RESULTS: When first diagnosed, there were no significant differences in FPG and 2 h PG levels in 2 groups (P>0.50). When delivery, FPG and 2 h PG levels in 2 groups were significantly lower than first diagnosed, and observation group was lower than control group, the differences were statistically significant (P<0.05). The incidence of premature delivery, gestational hypertension, neonatal asphyxia, low-weight children and neonatal hypoglycemia in observation group were significantly lower than control group, Apgar score was significantly higher than control group, the differences were statistically significant (P<0.05); and there were no significant differences in the incidence of polyhydramnios, multi-cesarean and fetal macrosomia in 2 groups(P>0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS: Based on diet control, insulin in the treatment of gestational diabetes before pregnant 30 weeks can effectively control blood glucose level and improve pregnancy outcomes, with good safety.
期刊: 2016年第27卷第18期
作者: 翟悦静,李彩辉,朱慧芳
AUTHORS: ZHAI Yuejing,LI Caihui,ZHU Huifang
关键字: 胰岛素;妊娠期糖尿病;不同孕周;疗效;安全性
KEYWORDS: Insulin; Gestational diabetes; Different gestational age; Efficacy; Safety
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