基礎—餐時胰島素治療糖尿病合并妊娠臨床觀察及其對妊娠結局的影響

陳園勝+陳友方+宋濤

【摘要】 目的：糖尿病合并妊娠者臨床行基礎-餐時胰島素治療，觀察其降糖效果、孕婦妊娠結局以及新生兒情況。方法：選取本院住院部收治的36例糖尿病合并妊娠患者為研究對象，按照隨機數字表法分為兩組，其中對比組18例，觀察組18例，比較孕婦血糖指標變化情況，記錄孕婦血糖達標用時、胰島素用量，統計孕婦妊娠結局、低血糖以及新生兒情況。結果：觀察組孕婦不良妊娠結局、新生兒不良情況均較對比組少（P<0.05）；入院時兩組血糖指標比較差異均無統計學意義（P>0.05），胰島素治療后3個月空腹血糖、餐后2 h血糖以及糖化血紅蛋白水平觀察組均明顯低于對比組（P<0.05）；對比組低血糖發生率為27.8%，高于觀察組的5.6%（P<0.05）；觀察組血糖達標用時、胰島素使用量均較對比組少（P<0.05）。結論：糖尿病合并妊娠患者使用基礎-餐時胰島素治療能有效控制孕婦血糖，降低低血糖的發生率，減少不良妊娠結局的發生。

【關鍵詞】 基礎-餐時胰島素； 糖尿病合并妊娠； 妊娠結局

【Abstract】 Objective：To observe the clinical effect of basal-prandial Insulin in pregnant patients complicated with diabetes mellitus and its impact in the pregnancy outcome and neonatal complications.Method：A total of 36 pregnant patients complicated with diabetes mellitus in our hospital were selected.The subjects were randomly divided into the control group and the observation group，18 cases in each group.The blood glucose was recorded，the time of achieving the standard blood glucose，dose of Insulin as well as the pregnancy outcome，incidence rate of hypoglycemia and neonatal complications of two groups were observed.Result：The incidence rate of adverse pregnancy outcomes and neonatal complications of the observation group were lower than those of the control group（P<0.05）.Upon admission to hospital，the blood glucose of two groups were not significantly different（P>0.05）.After 3 months of treatment，the fasting blood glucose，2 h postprandial blood glucose and glycosylated hemoglobin of the observation group were significantly lower than those of the control group（P<0.05）.The incidence rate of hypoglycemia of the control group（27.8%） was significantly higher than that of the observation group（5.6%）（P<0.05）.The time of achieving the standard blood glucose，dose of insulin of the observation group were better than those of the control group（P<0.05）.Conclusion：For pregnant patients complicated with diabetes mellitus，basal-prandial Insulin can effectively control the blood glucose，reduce the incidence rate of hypoglycemia and adverse pregnancy outcomes.

【Key words】 Basal-prandial Insulin； Pregnant patients complicated with diabetes mellitus； Pregnancy outcomes

First-authors address：Nanxiong Peoples Hospital，Nanxiong 512400，China

doi：10.3969/j.issn.1674-4985.2017.29.009

糖尿病合并妊娠包括妊娠期糖尿病（GDM）和孕前糖尿病（PGDM），其中GDM發病率約占糖尿病合并妊娠的80%～90%，但只有不到5%孕婦需要使用胰島素治療才能控制血糖，而PGDM患者在孕前已確診或在妊娠期首次被診斷，故需要使用胰島素控制血糖[1-2]。胰島素是臨床糖尿病合并妊娠治療藥物首選，但不同胰島素以及不同給藥方式，臨床降糖效果會有差異，有學者提出患者三餐前及睡前用藥，不僅有良好降糖效果，同時血糖波動穩定，不良妊娠結局發生少[3-4]。本文觀察基礎-餐時胰島素治療方案應用于PGDM患者的效果，現報道如下。endprint

1 資料與方法

1.1 一般資料 以本院住院部2015年1月-2017年3月收治的36例糖尿病合并妊娠（PGDM）患者為研究對象，納入標準：患者年齡在24～38歲，孕婦有糖尿病史或妊娠期首次就診時血糖達到糖尿……