徐丹芬　赵卓姝　温倩敏

[摘要] 目的 探討与分析胰岛素治疗妊娠糖尿病的起始剂量与妊娠结局的相关性。方法 2015年5月—2018年12月选择诊治的106例妊娠糖尿病孕妇，根据随机数字表法分为低剂量组与高剂量组各53例。高剂量组：给予胰岛素1日多次给药治疗，门冬胰岛素注射液初始剂量0.5 U/（kg·d），低剂量组给予胰岛素泵持续治疗，门冬胰岛素注射液起始剂量0.2 U/（kg·d），两组疗程均为4周，记录两组妊娠结局。结果 低剂量组的胰岛素用量显著低于高剂量组（P<0.05），两组血糖达标时间对比差异无统计学意义（P>0.05）。两组治疗后的FPG与2 hPG值都显著低于治疗前（P<0.05）。所有孕妇都顺利完成分娩，低剂量组的羊水过多、早产、妊娠期高血压、低血糖等并发症发生率为3.8%，显著低于高剂量组的24.5%（P<0.05）。低剂量组的新生儿高胆红素血症、新生儿低血糖、新生儿窒息、巨大儿等并发症发生率为3.8%，显著低于高剂量组的26.4%（P<0.05）。结论 基于初始低剂量的胰岛素泵注射方式在妊娠糖尿病孕妇中的应用能减少胰岛素的应用剂量，能达到同样的降糖效果，改善孕妇与新生儿的预后。

[关键词] 初始剂量;胰岛素泵;妊娠糖尿病;妊娠结局

[中图分类号] R714.256          [文献标识码] A          [文章编号] 1672-4062（2020）02（a）-0072-04

Correlation Analysis Between the Initial Dose of Insulin Treatment for Gestational Diabetes and Pregnancy Outcome

XU Dan-fen， ZHAO Zhuo-shu， WEN Qian-min

Department of Obstetrics and Gynecology， Shunde Women's and Children's Hospital of Guangdong Medical University（Foshan Shunde District Maternal and Child Health Hospital）， Foshan， Guangdong Province， 528300 China

[Abstract] Objective To explore and analyze the correlation between the initial dose of insulin for gestational diabetes and pregnancy outcome. Methods From May 2015 to December 2018， 106 pregnant women with gestational diabetes were selected for diagnosis and treatment. They were divided into low-dose group and high-dose group with 53 cases according to the random number table method. High-dose group： Insulin was administered multiple times a day. The initial dose of insulin aspart was 0.5 U/（kg·d）. The low-dose group was given continuous treatment with an insulin pump. The initial dose of insulin aspart was 0.2 U/（kg·d）， the treatment course of both groups was 4 weeks， and the pregnancy outcomes of the two groups were recorded. Results The dosage of insulin in the low-dose group was significantly lower than that in the high-dose group（P<0.05）， and there was no significant difference in blood glucose compliance time between the two groups（P>0.05）. The FPG and 2 hPG values after treatment in both groups were lower before treatment（P<0.05）. All pregnant women completed delivery successfully. The incidence of complications such as polyhydramnios， premature delivery， hypertension during pregnancy， and hypoglycemia in the low-dose group was 3.8%， which was significantly lower than 24.5% in the high-dose group（P<0.05）. The complication rate of neonatal hyperbilirubinemia， neonatal hypoglycemia， neonatal asphyxia， and giant infants in the low-dose group was 3.8%， which was significantly lower than 26.4% in the high-dose group（P<0.05）. Conclusion The application of the initial low-dose insulin pump injection method in pregnant women with gestational diabetes can reduce the dosage of insulin， achieve the same effect of lowering glucose， and improve the prognosis of pregnant women and newborns.

妊娠糖尿病是妊娠期合并症之一，属于高危妊娠，与多种不良妊娠结局相关，还可能长期影响胎儿神经系统及精神发育，早期有效控制血糖水平被认为是治疗妊娠糖尿病与改善孕妇、围产儿预后的关键[17-18]。外源性胰岛素可有效降低妊娠糖尿病孕妇血糖水平，最大程度模拟胰岛素生理性分泌模式，从而降低围生期母婴不良结局发生风险[19-20]。特别是通过微量输注胰岛素的方式，可有效降低孕妇低血糖发生风险，避免夜间血糖异常波动[21-22]。该研究显示所有孕妇都顺利完成分娩，低剂量组的羊水过多、早产、妊娠期高血压、低血糖等并发症发生率为3.8%，显著低于高剂量组的24.5%（P<0.05）;低剂量组的新生儿高胆红素血症、新生儿低血糖、新生儿窒息、巨大儿等并发症发生率为3.8%，显著低于高剂量组的26.4%（P<0.05）。表明胰岛素泵注射治疗能改善孕妇与新生儿的预后。并且胰岛素泵具有操作简单、携带方便等优势，能够更灵活地设定不同时段输注参数，也可通过小剂量追加胰岛素等方式降低治疗成本[23-25]。不过该次研究样本量较少，随访时间比较短，且机制分析不够深入，在今后的研究中将进行重点分析。

綜上所述，基于初始低剂量的胰岛素泵注射方式在妊娠糖尿病孕妇中的应用能减少胰岛素的应用剂量，能达到同样的降糖效果，能改善孕妇与新生儿的预后。……