摘要
目的分析妊娠合并糖尿病(糖尿病合并妊娠及妊娠期糖尿病)患者应用门冬胰岛素联合不同方案(地特胰岛素、精蛋白生物合成人胰岛素)治疗的临床疗效。方法方便选择该院2016年10月-2018年10月收治的420例妊娠合并糖尿病患者为研究对象,签署知情同意书。按照随机双盲法分为两组,每组210例。两组均接受门冬胰岛素治疗,根据联合方案不同分为对照组与观察组,对照组联合精蛋白生物合成人胰岛素(NPH)治疗,观察组联合地特胰岛素治疗。检测治疗前后空腹血糖、餐后2 h血糖,评价妊娠结局(主要从剖宫产率、妊娠高血压、新生儿情况评价),记录两组胰岛素用量、注射次数、空腹血糖达标时间、餐后2 h血糖达标时间,并予以统计学分析。结果两组治疗前空腹血糖、餐后2 h血糖对比差异无统计学意义(P>0.05),治疗后观察组餐后2 h血糖显著低于对照组[(6.39±1.23) mmol/L vs (7.94±1.04)mmol/L(t=13.945,P<0.05)];两组剖宫产率、妊娠高血压率、巨大儿率、新生儿高胆红素血症率、新生儿低血糖率对比差异无统计学意义(P>0.05);两组胰岛素用量差异无统计学意义(P>0.05),但观察组注射次数、空腹血糖与餐后2 h血糖达标时间均显著低于对照组[(3.22±0.41)次/d vs(4.34±0.37)次/d(t=29.389,P<0.05);(4.01±1.96)d vs(6.47±2.36)d(t=11.620,P<0.05);(4.65±2.31)d vs (7.55±2.83)d(t=11.504,P<0.05)]。结论门冬胰岛素联合地特胰岛素方案与门冬胰岛素联合NPH方案治疗妊娠合并糖尿病患者比较,在产妇与新生儿结局以及降低空腹血糖指标上,胰岛素用量上差异不明显,但是前者可以更好地改善餐后2 h血糖指标,减少胰岛素每天注射次数,促进血糖指标更快达标,值得在临床应用。
Objective To analyze the clinical efficacy of insulin aspart in combination with different regimens(tete insulin,protamine biosynthesis human insulin) in patients with diabetes mellitus(diabetes with pregnancy and gestational diabetes).Methods Convenient selec a total of 420 pregnant patients with diabetes mellitus admitted to the hospital from October2016 to October 2018 were enrolled in the study. Informed consent was obtained. According to the random double-blind method, the patients were divided into two groups, 210 cases in each group. Both groups received insulin asparts treatment.They were divided into control group and observation group according to the joint protocol. The control group was treated with protamine biosynthesis human insulin(NPH). The observation group was treated with insulin detemir. Fasting blood glucose before and after treatment, blood glucose 2 h after meal, evaluation of pregnancy outcome(mainly from cesarean section rate, pregnancy-induced hypertension, evaluation of neonatal condition), recording the insulin dosage, number of injections, fasting blood glucose compliance time, 2 h postprandial blood glucose time to meet the standard and statistical analysis. Results There was no significant difference in fasting blood glucose and 2 h postprandial blood glucose between the two groups(P>0.05). After treatment, the blood glucose at 2 h after the observation was significantly lower than that of the control group [(6.39 ±1.23)mmol/L vs(7.94±1.04)mmol/L(t=13.945, P<0.05)];there was no significant difference between the two groups in cesarean section rate,pregnancy-induced hypertension rate, macro-child rate, neonatal hyperbilirubinemia rate, and neonatal hypoglycemia rate(P>0.05). There was no significant difference in insulin dosage between the two groups(P>0.05), but the number of injections, fasting blood glucose and 2 h postprandial blood glucose compliance time in the observation group were significantly lower than those in the control group [(3.22±0.41) times/d vs(4.34±0.37) times/d(t=29.389, P<0.05);(4.01±1.96) d vs(6.47±2.36) d(t=11.620, P<0.05);(4.65±2.31)d vs(7.55±2.83) d(t=11.504, P<0.05)]. Conclusion Insulin aspartate combined with insulin detemir and insulin aspartate combined with NPH regimen in the treatment of pregnancy with diabetes, the maternal and neonatal outcomes, as well as the reduction of fasting blood glucose, insulin dosage is not obvious, but the former can be better improved 2 h postprandial blood glucose index, reduce the number of daily injections of insulin, promote blood glucose indicators to reach the standard faster, worthy of clinical application.
作者
孟贵琴
王小青
徐雅静
MENG Gui-qin;WANG Xiao-qing;XU Ya-jing(Department of Obstetrics,Datong Third Hospital,Datong,Shanxi Province,037000 China)
出处
《中外医疗》
2019年第31期101-103,106,共4页
China & Foreign Medical Treatment
