论文部分内容阅读
目的探讨妊娠期糖尿病(GDM)筛查、诊断与治疗的方法,力求减少和避免孕期、产时及产后GDM对母儿的危害。方法对我院2003年8月至2004年9月2218例门诊产前检查的孕妇进行50克葡萄糖筛查试验,糖筛阳性者行75克糖耐量诊断试验,对糖耐量减低及妊娠期糖尿病者先给予饮食及运动治疗,治疗效果不理想者予胰岛素治疗。糖筛试验阳性258例(13.9%),75克糖耐量减低42例(2.25%),妊娠期糖尿病24例(1.25%)。此324例孕妇,予饮食、运动治疗指导。一周后血糖达理想范围者295例(91.05%),295例病人严格遵守各自的饮食、运动治疗方案,定期复检餐后2小时微量血糖(2次/周),均安全渡过围产期。血糖控制不理想者29例(8.95%)给予胰岛素治疗,包括GDM23例、75克糖耐量减低6例。本文就配合接受胰岛素治疗并于我院终止妊娠的19例患者为研究对象,分为两组:A组.胰岛素治疗及时血糖控制良好者1l例,B组.未规范治疗或因病人就诊较晚已≥36周而失去治疗时机者8例。对两组病人经饮食、运动及胰岛素治疗前、后一周左右的平均血糖值变化、母儿并发症、分娩孕周、分娩方式及新生儿Apgar评分进行比较分析。结果1.饮食、运动治疗是妊娠期糖尿病基础治疗,治疗得当有70%-80%的病人可达满意疗效,减少或免除胰岛素的使用。2.经胰岛素治疗者,A组治疗前后血糖值相比均有极显著意义(P<0.001),B组属未规范治疗,经饮食、运动及胰岛素治疗后血糖亦有显著变化(P<0.001);两组剖宫产率相比接近,但B组因头盆不称而剖宫产5例,而A组只有2例,其余为社会因素,故两组差异显著(p<0.05)。结论50g萄糖筛查试验在GDM诊断中起着关键性的作用。75克糖耐量试验是诊断试验,GDM治疗模式以饮食、运动治疗为基础,需用药物治疗时,选用人胰岛素制剂,合理使用胰岛素,使血糖控制于理想范围内,可减少母儿并发症的发生。
Objective To explore the methods of screening, diagnosis and treatment of gestational diabetes mellitus (GDM) in order to reduce and avoid the harm of GDM during pregnancy, birth and postnatal period. Methods A total of 2218 pregnant women with prenatal examination from 2218 outpatients in our hospital from August 2003 to September 2004 were screened for 50g glucose test, and 75g glucose tolerance test was performed on those with positive glycobulves. The patients with impaired glucose tolerance and gestational diabetes mellitus First give diet and exercise therapy, treatment is not ideal for insulin treatment. Saccharin screening tests were positive in 258 cases (13.9%), with 75 grams of impaired glucose tolerance in 42 cases (2.25%) and gestational diabetes in 24 cases (1.25%). The 324 cases of pregnant women, diet, exercise therapy guidance. One week later, 295 patients (91.05%) got the ideal range of blood glucose. 295 patients strictly followed their diet and exercise regimens. The patients were given 2-hour postprandial micro-glucose (2 times / week) . Twenty-nine patients (8.95%) with poor glycemic control were given insulin therapy, including 23 cases of GDM and 6 cases of impaired glucose tolerance. In this paper, with the acceptance of insulin treatment and termination of pregnancy in our hospital 19 patients for the study, divided into two groups: group A. Insulin treatment of patients with good glycemic control in patients with l1, group B. nor standard treatment or due to patient treatment later Has been ≥ 36 weeks and lost treatment time in 8 cases. The changes of mean blood glucose level, maternal and child complications, gestational gestational age, mode of delivery and neonatal Apgar score were compared between the two groups before and after diet, exercise and insulin treatment. Results 1. Diet, exercise therapy is the basic treatment of gestational diabetes, properly treated 70% -80% of patients up to satisfactory efficacy, reduce or eliminate the use of insulin. In insulin-treated group, the blood glucose level in group A was significantly higher than that in group A before and after treatment (P <0.001). In group B, there was no standard treatment, and there was a significant change in blood glucose after diet, exercise and insulin treatment ). The rate of cesarean section was similar between the two groups. However, there were 5 cases of cesarean section in group B due to the lack of cupping. There were only 2 cases in group A and the rest were social factors. The difference was significant (p <0.05). Conclusion 50g glucose screening test plays a key role in the diagnosis of GDM. 75 grams of glucose tolerance test is a diagnostic test, GDM treatment model based on diet, exercise therapy, the need for drug treatment, the choice of human insulin preparations, the rational use of insulin, blood glucose control in the ideal range, can reduce maternal and child complications occur.