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目的:探讨妊娠期糖尿病(GDM)患者孕期不同治疗方法与母儿妊娠结局的关系。方法:对GDM 140例分为3组,A组:胰岛素治疗组+饮食控制31例;B组:饮食控制血糖不满意时用胰岛素治疗35例;C组:单纯饮食控制血糖74例,比较3组母儿妊娠结局。根据孕期首次使用胰岛素孕周将病例分为两组:Ⅰ组32例(平均胰岛素起始孕周26周),Ⅱ组34例(平均胰岛素起始孕周33+3周),比较两组母儿结局。结果:3组血糖基本控制在正常范围,A组剖宫产、妊娠期高血压疾病、酮症、巨大儿、胎儿窘迫、新生儿高胆红素血症、新生儿低血糖发生率低于B组及C组,差异有统计学意义(P<0.05)。早产差异无统计学意义(P>0.05)。Ⅰ组剖宫产率、新生儿高胆红素血症、胎儿窘迫与Ⅱ组差异无统计学意义(P>0.05),而酮症、巨大儿、羊水过多、妊娠期高血压、新生儿低血糖都要低于Ⅱ组差异有统计学意义(P<0.05)。结论:对GDM患者饮食控制同时加用胰岛素治疗,与饮食控制不满意后再加用胰岛素治疗相比,前者可以明显改善母婴结局,尤其是体重指数偏高患者。孕期饮食控制基础上早用胰岛素比晚用胰岛素可以改善母婴结局。
Objective: To investigate the relationship between gestational diabetes mellitus (GDM) and different pregnancy methods in pregnant women and children. Methods: 140 cases of GDM were divided into three groups, Group A: insulin treatment group and diet control of 31 cases; Group B: 35 cases of insulin control when blood glucose was not satisfied with diet control; Group C: 74 cases of simple diet control blood glucose, compared with 3 Group mother and child pregnancy outcomes. The patients were divided into two groups according to the gestational weeks of gestational insulin: gestational age group I (32 weeks average gestational age of 26 weeks), group II 34 (average gestational age 33 + 3 weeks) Children’s ending. Results: The three groups of blood glucose control in the normal range, A group of cesarean section, gestational hypertension, ketosis, macrosomia, fetal distress, neonatal hyperbilirubinemia, neonatal hypoglycemia incidence was lower than B Group and group C, the difference was statistically significant (P <0.05). No significant difference in preterm labor (P> 0.05). The incidence of cesarean section, neonatal hyperbilirubinemia and fetal distress in group Ⅰ were not significantly different from those in group Ⅱ (P> 0.05). However, ketosis, macrosomia, polyhydramnios, gestational hypertension, neonatal Hypoglycemia should be lower than the difference between the two groups was statistically significant (P <0.05). Conclusion: Diet control of GDM patients with insulin treatment at the same time, and diet control is not satisfied with the addition of insulin treatment, the former can significantly improve maternal and infant outcomes, especially in patients with high body mass index. Pregnancy diet control based on early use of insulin than late insulin can improve maternal and infant outcomes.