胰岛素两种给药方式对高龄妊娠期糖尿病患者相关指标的影响比较

发布时间：2018-05-04 10:56

本文选题：胰岛素 + 胰岛素泵　；参考：《中国药房》2017年15期

【摘要】：目的:比较多次皮下给予胰岛素与胰岛素泵持续皮下给予胰岛素对高龄妊娠期糖尿病(GDM)患者相关指标的影响。方法:回顾性分析120例高龄GDM患者资料,按用药方式的不同分为A组(60例)和B组(60例)。A组患者给予门冬胰岛素注射液初始剂量0.5 U/(kg·d),根据空腹血糖(FPG)和餐后2 h血糖(2hPG)调整剂量,于三餐前皮下注射+精蛋白生物合成人胰岛素注射液初始剂量0.5 U/(kg·d),根据FPG和2hPG调整剂量,每日睡前皮下注射。B组患者给予门冬胰岛素注射液初始剂量0.5 U/(kg·d),加入胰岛素泵,以每日胰岛素总量的40%作为基础泵注量,如血糖控制效果不佳则追加总量的60%,根据FPG和2hPG调整剂量。两组疗程均为4周。观察两组患者血糖达标时间和胰岛素用量,治疗前后FPG、2hPG、糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)水平,患者及新生儿并发症发生情况。结果:B组患者血糖达标时间显著短于A组,胰岛素用量及低血糖、早产、羊水过多、妊娠期高血压发生率均显著低于A组,差异均有统计学意义(P0.05)。B组新生儿呼吸窘迫综合征发生率显著低于A组,差异有统计学意义(P0.05);但两组巨大儿、畸形发生率比较,差异均无统计学意义(P0.05)。治疗后,两组患者FPG、2hPG、Hb A1c、Hcy、Cys-C水平均显著低于同组治疗前,且B组显著低于A组,差异均有统计学意义(P0.05)。结论:胰岛素泵持续皮下给予胰岛素在有效控制高龄GDM患者血糖水平、降低胰岛素用量、下调Hcy和Cys-C水平、减少母婴并发症的发生方面均显著优于多次皮下给予胰岛素。
[Abstract]:Aim: to compare the effects of multiple subcutaneous insulin administration and insulin pump continuous subcutaneous insulin administration on the related indexes in elderly patients with gestational diabetes mellitus (GDM). Methods: the data of 120 elderly patients with GDM were retrospectively analyzed. Group A (n = 60) and group B (n = 60) were treated with insulin aspartic injection (n = 60). The dose was adjusted according to fasting blood glucose (FBG) and postprandial blood glucose (2 h). The preprandial injection of protamine biosynthetic human insulin injection was subcutaneously injected at an initial dose of 0.5 U/(kg dU. According to the adjustment of FPG and 2hPG, the patients in group B were injected subcutaneously before bedtime with the initial dose of insulin aspartate injection (0.5 U/(kg d), and the insulin pump was added. Take 40% of the total insulin daily as the basic pump dose, if the effect of blood glucose control is not good, then add 60% of the total amount, adjust the dose according to FPG and 2hPG. The course of treatment was 4 weeks in both groups. The time of blood glucose standard and the dosage of insulin were observed. Before and after treatment, the levels of FPG 2 h PGN, HbA1cU, Hcysteine, cystatin Cy Cys-Clevel, complications of patients and newborns were observed. Results the time of blood glucose standard in group B was significantly shorter than that in group A. the dosage of insulin and hypoglycemia, premature delivery, amniotic fluid excess, and the incidence of hypertension complicating pregnancy were significantly lower than those in group A. The incidence of neonatal respiratory distress syndrome in group B was significantly lower than that in group A (P 0.05), but there was no significant difference between the two groups in the incidence of macrosomia and malformation (P 0.05). After treatment, the levels of PGHb HbA1cHcycyCys-C in the two groups were significantly lower than those in the same group before treatment, and that in group B was significantly lower than that in group A, the difference being statistically significant (P 0.05). Conclusion: continuous subcutaneous insulin administration with insulin pump is superior to repeated subcutaneous insulin administration in controlling blood glucose level, decreasing insulin dosage, lowering Hcy and Cys-C levels, and reducing the incidence of maternal and infant complications in elderly patients with GDM.
【作者单位】：河北省人民医院产科;
【基金】：河北省医学科学研究重点课题计划(No.20150584)
【分类号】：R714.256

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