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目的:评价不同时机综合干预的介入对妊娠期糖尿病(GDM)患者围手术期应激反应及母婴预后的影响。方法:选取该院妇产科2013年1月~12月收治的GDM患者95例,采用随机数字表法,将患者随机分为三组:妊娠期间血糖正常的33例为Ⅰ组,孕中期(孕24~28周)确定为GDM的32例为Ⅱ组、>孕28周被确诊为GDM的30例为Ⅲ组。三组患者均在确诊后给予综合干预治疗,对比观察三组患者围手术期应激反应的程度及母婴预后情况。结果:围手术期应激反应水平:与Ⅰ组相比,Ⅱ组、Ⅲ组均表现出较高水平的应激反应,同时Ⅱ组较Ⅲ组弱且皮质醇恢复较早,差异有统计学意义(P<0.05);母婴预后方面:围生期并发症如羊水过多、妊娠期高血压疾病、酮症酸中毒、产后感染方面和围生期结局如早产儿、巨大儿、新生儿低血糖、新生儿窒息的发生率方面,Ⅰ组患者较Ⅱ、Ⅲ组显著减少,Ⅱ组较Ⅲ组显著减少,差异有统计学意义(P<0.05)。结论:对于GDM患者坚持进行早筛查、早诊治及合适的治疗方式,对母婴健康非常重要。
Objective: To evaluate the effect of intervention at different timing on perioperative stress response and maternal and infant prognosis in patients with gestational diabetes mellitus (GDM). Methods: Ninety-five patients with GDM admitted to our hospital from January to December 2013 were randomly divided into three groups: 33 cases with normal blood glucose during pregnancy were Group Ⅰ, Pregnancy 24 to 28 weeks) identified 32 cases of GDM as group Ⅱ,> 30 weeks pregnant 28 weeks was diagnosed as GDM group Ⅲ. All three groups were given comprehensive intervention after diagnosis. The degree of perioperative stress response and maternal and infant prognosis were compared among the three groups. Results: Perioperative stress response: Compared with group Ⅰ, group Ⅱ and group Ⅲ showed a higher level of stress response, while group Ⅱ was weaker than group Ⅲ and cortisol recovered earlier with the difference statistically (P <0.05); maternal and infant prognosis: perinatal complications such as polyhydramnios, gestational hypertension, ketoacidosis, postpartum infection and perinatal outcomes such as premature children, macrosomia, neonatal In terms of incidence of hypoglycemia and neonatal asphyxia, the number of patients in group I was significantly lower than that of patients in group II and group III, and the number of patients in group II was significantly lower than that in group III (P <0.05). Conclusion: Insisting on early screening, early diagnosis and treatment and appropriate treatment for GDM patients is very important for maternal and infant health.