本文選題：妊娠期糖尿病 + 療效觀察�。� 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：[研究背景]妊娠期糖尿病是指妊娠期發(fā)生或首次發(fā)現(xiàn)的不同程度的糖耐量異常,不包括妊娠前已診斷的糖尿病。妊娠期糖尿病的定義和診斷標(biāo)準(zhǔn),在不斷的爭(zhēng)議討論中發(fā)展、完善。據(jù)世界各地流行病學(xué)調(diào)查顯示,妊娠期糖尿病的發(fā)病率種族間存在著明顯差異,由于國(guó)際上尚無(wú)統(tǒng)一的診斷標(biāo)準(zhǔn),國(guó)內(nèi)亦無(wú)推薦使用的統(tǒng)一標(biāo)準(zhǔn),再加上診斷標(biāo)準(zhǔn)的不斷變化,因此,各國(guó)報(bào)道的發(fā)病率相差懸殊,為1%-14%,我國(guó)內(nèi)發(fā)病率為1%-4%,且呈逐年上升的趨勢(shì)。鑒于妊娠期糖尿病發(fā)病率不斷增加和嚴(yán)重的危害性,故及時(shí)有效的治療就顯得格外重要。目前,對(duì)妊娠期糖尿病的發(fā)病機(jī)制尚未完全明確,根據(jù)最新的研究進(jìn)展,其發(fā)病可能與遺傳易感性、脂肪因子、慢性炎癥反應(yīng)、肥胖、運(yùn)動(dòng)量、飲食、孕婦年齡及心理社會(huì)應(yīng)激等有關(guān)。因妊娠期糖尿病會(huì)導(dǎo)致一系列母、兒孕期并發(fā)癥發(fā)生率增加,包括：巨大胎兒、宮內(nèi)慢性缺氧、胎兒心臟發(fā)育異常、羊水過(guò)多、胎膜早破、早產(chǎn)、新生兒低血糖等情況。只有在整個(gè)妊娠期中,控制母體血糖至正常范圍,才能改善妊娠期糖尿病孕婦母、兒的結(jié)局。目前臨床治療方法包括飲食療法、運(yùn)動(dòng)療法、胰島素使用等,需要指出的是,胰島素治療必須在飲食治療的基礎(chǔ)上進(jìn)行,否則效果不滿(mǎn)意。飲食、運(yùn)動(dòng)等非藥物治療是妊娠期糖尿病不可替代的、有效的,也是主要的治療方法,其在控制血糖,減少?lài)a(chǎn)期母嬰并發(fā)癥和減少胰島素用量等方面都有確切的臨床療效；口服降糖藥因其可能導(dǎo)致畸胎、巨大兒、新生兒低血糖,甚至死亡等故在妊娠期糖尿病的使用存在著較大爭(zhēng)議,我國(guó)目前仍以胰島素作為妊娠期糖尿病唯一藥物治療,但是胰島素最佳治療劑量尚無(wú)統(tǒng)一標(biāo)準(zhǔn),國(guó)內(nèi)外學(xué)者普遍認(rèn)為胰島素用量應(yīng)個(gè)體化,并充分考慮胎盤(pán)激素隨著妊娠的進(jìn)展而對(duì)胰島素敏感性的影響,及時(shí)調(diào)整胰島素用量。臨床上,對(duì)妊娠期糖尿病患者目前以飲食運(yùn)動(dòng)為主,當(dāng)飲食運(yùn)動(dòng)干預(yù)后,血糖仍無(wú)法達(dá)標(biāo)者,需要盡快使用胰島素控制血糖。不可否認(rèn),也取得了一定效果�，F(xiàn)有的治療手段往往忽略了孕婦最常見(jiàn)的心理應(yīng)激產(chǎn)生的影響。妊娠期糖尿病血糖升高特點(diǎn)為：餐后血糖升高較快,空腹及夜間容易出現(xiàn)低血糖。所以妊娠期糖尿病血糖控制治療方案選擇,應(yīng)保證和提供妊娠期間母體、胎兒發(fā)育正常所需熱量和營(yíng)養(yǎng)需要,避免餐后高血糖或饑餓性酮癥出現(xiàn),血糖控制在正常方案。考慮到妊娠是婦女特殊的生理階段,孕婦易情緒緊張,血糖水平波動(dòng)大,因此增加了控制血糖的難度,心理調(diào)節(jié)有助于改善孕婦情緒,減少憂郁,使其積極配合飲食控制及其他治療,有利于血糖的調(diào)節(jié)。從而達(dá)到平穩(wěn)控制血糖,預(yù)防低血糖發(fā)生。但目前心理治療的研究尚處于發(fā)展階段,還需要大量的隊(duì)列性臨床研究來(lái)證實(shí)其治療作用。上述每種因素都與妊娠期糖尿病的發(fā)生有相關(guān)性,但目前為止,用上述任何一種病因都無(wú)法單獨(dú)解釋妊娠期糖尿病的發(fā)生機(jī)制,可能是上述各因素相互作用的結(jié)果。多數(shù)學(xué)者認(rèn)為該病發(fā)生是綜合因素作用的結(jié)果,而在妊娠期糖尿病的發(fā)病機(jī)制研究中,心理社會(huì)應(yīng)激方面的研究明顯不足,近年來(lái)發(fā)現(xiàn)5-羥色胺(5-HT)直接或間接參與了心理調(diào)節(jié),研究發(fā)現(xiàn)在妊娠期糖尿病患者中,SCL-90積分與血清5-HT水平呈正相關(guān),提示在妊娠期糖尿病的患者中,5-HT含量的改變同樣是該病患者心理狀況不良的一個(gè)重要環(huán)節(jié),在心理干預(yù)的評(píng)估中其重要作用。在治療上,考慮到妊娠期的特殊性,確診妊娠期糖尿病后,均應(yīng)以生活方式干預(yù)為主,藥物在生活方式干預(yù)下血糖仍控制不佳時(shí)使用。而對(duì)心理干預(yù)治療的效果評(píng)價(jià)研究相對(duì)不足,現(xiàn)有這方面的研究也存在疾病診斷標(biāo)準(zhǔn)不統(tǒng)一、樣本含量偏少、癥狀缺乏統(tǒng)一公認(rèn)的分級(jí)量化指標(biāo)與療效評(píng)定標(biāo)準(zhǔn)、觀察時(shí)間有限,缺乏長(zhǎng)期隨訪、無(wú)基礎(chǔ)研究作為支持等,故無(wú)法明確其治療機(jī)理。本研究根據(jù)2011年我國(guó)頒布實(shí)施的妊娠期糖尿病診斷行業(yè)標(biāo)準(zhǔn),并參照美國(guó)糖尿病學(xué)會(huì)2013年的妊娠期糖尿病診治標(biāo)準(zhǔn)的相關(guān)規(guī)定,以此作為研究參考,對(duì)比三組治療妊娠期糖尿病情況,觀察心理干預(yù)方式治療療效。[目的]1、觀察三種方式治療妊娠期糖尿病患者在降低空腹血糖、OGTT后1h、2h血糖、糖化血紅蛋白及血清5-HT含量,改善患者病情、提高遠(yuǎn)期療效等方面的作用,客觀評(píng)價(jià)其臨床療效；2、觀察心理干預(yù)治療對(duì)妊娠期糖尿病的療效,從而為臨床應(yīng)用提供一種有效的治療方案。[方法]1、試驗(yàn)設(shè)計(jì)方案本項(xiàng)研究所有病例均來(lái)自2013年1月至2013年12月南方醫(yī)科大學(xué)附屬?gòu)V東省第二人民醫(yī)院內(nèi)分泌科門(mén)診及住院病房。納入標(biāo)準(zhǔn)：參照2011年我國(guó)頒布實(shí)施的妊娠期糖尿病診斷行業(yè)標(biāo)準(zhǔn)而制定如下：診斷一步法：不必行50g葡萄糖負(fù)荷試驗(yàn)(GCT),而妊娠24周-28周直接行75g葡萄糖耐量試驗(yàn)(OGTT)。75gOGTT的正常值：空腹、服葡萄糖后1h、2h血糖值分別小于5.1mmol/L、10.0mmol/L、8.5mmol/L。任意一點(diǎn)血糖值異常者應(yīng)診斷為妊娠期糖尿病。將所有確診娠期糖尿病入選病例作為受試對(duì)象,以就診時(shí)間順序編號(hào),根據(jù)隨機(jī)數(shù)字表法均分成4組。分別為對(duì)照組：?jiǎn)渭兩罘绞礁深A(yù)37例,試驗(yàn)A組：生活方式干預(yù)+胰島素37例,試驗(yàn)B組：生活方式干預(yù)+心理干預(yù)37例,試驗(yàn)C組：生活方式干預(yù)+心理干預(yù)+胰島素組37例。2、治療方法對(duì)照組：?jiǎn)渭兩罘绞礁深A(yù)患者采取健康宣傳、運(yùn)動(dòng)、飲食指導(dǎo)聯(lián)合干預(yù)治療。運(yùn)動(dòng)以家庭上肢運(yùn)動(dòng)(每天30min,每天3次)和散步(每天40min,餐后1h后進(jìn)行)相結(jié)合為主,飲食方面有營(yíng)養(yǎng)師專(zhuān)門(mén)指導(dǎo),碳水化合物、蛋白質(zhì)、脂肪能量比大約為4：3：3。試驗(yàn)A組：生活方式干預(yù)+胰島素,患者在生活方式干預(yù)的基礎(chǔ)上加用門(mén)冬胰島素注射液諾和銳,NovoRapidPenfill,生產(chǎn)批號(hào)：CVG0519),每天三餐前皮下注射,小劑量1-2單位開(kāi)始,然后根據(jù)血糖監(jiān)測(cè),調(diào)整劑量。如空腹血糖仍不達(dá)標(biāo),≥5.3mmol/L時(shí),給予加用諾和靈N睡前皮下注射治療,小劑量開(kāi)始,根據(jù)血糖調(diào)整劑量。試驗(yàn)B組：生活方式干預(yù)+心理干預(yù),患者在生活方式干預(yù)基礎(chǔ)上配合心理干預(yù)治療,心理干預(yù)的具體方法為：由心理治療師專(zhuān)人負(fù)責(zé)對(duì)妊娠期糖尿病患者進(jìn)行宣教、解釋病因、后果及預(yù)防措施,讓患者充分認(rèn)識(shí)到妊娠期糖尿病對(duì)孕產(chǎn)婦及圍產(chǎn)兒均有較大危害,應(yīng)予以重視。對(duì)一些伴有煩躁易怒,心情郁悶等情緒障礙的妊娠期糖尿病患者進(jìn)行溝通開(kāi)導(dǎo),緩解或消除患者不當(dāng)情緒,心理障礙嚴(yán)重者適當(dāng)行為認(rèn)知治療。試驗(yàn)C組：生活方式干預(yù)+心理干預(yù)+胰島素,患者在生活方式干預(yù)下加用胰島素與心理干預(yù)治療。四組患者治療,2周為一個(gè)觀察和檢測(cè)療程,共4個(gè)療程,并在療程結(jié)束后對(duì)四組患者進(jìn)行回訪至生產(chǎn)。3、觀察指標(biāo)對(duì)比三試驗(yàn)組與對(duì)照組及三試驗(yàn)組間患者空腹血糖、餐后2小時(shí)血糖,4個(gè)療程結(jié)束后的空腹血糖、OGTT試驗(yàn)1h、2h血糖水平、糖化血紅蛋白、血清5-HT含量的變化,以及治療過(guò)程中低血糖發(fā)生、孕期母嬰不良情況發(fā)生,把收集的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理,比較三種方式對(duì)妊娠期糖尿病的治療效果。4、統(tǒng)計(jì)學(xué)處理及CRF表的制作向所有受試者詳細(xì)說(shuō)明參加臨床試驗(yàn)可能得到的利益與承擔(dān)的風(fēng)險(xiǎn),讓患者及家屬充分知情,征得患者同意并書(shū)面簽署知情同意書(shū)；按設(shè)計(jì)要求,統(tǒng)一表格,詳細(xì)記錄；認(rèn)真寫(xiě)好病例觀察表；各種數(shù)據(jù)均做統(tǒng)計(jì)學(xué)處理。調(diào)查表數(shù)據(jù)編碼量化后輸入計(jì)算機(jī),用SPSS13.0統(tǒng)計(jì)分析軟件處理,患病率以百分率表示,先對(duì)樣本資料進(jìn)行正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn)。所有數(shù)據(jù)均用以(x±s)表示,檢驗(yàn)以P0.05為有統(tǒng)計(jì)學(xué)意義。對(duì)于正態(tài)分布,且方差齊同的計(jì)數(shù)資料采用R×C表卡方(χ2)檢驗(yàn),Ridit分析。計(jì)量資料采用t檢驗(yàn)；對(duì)于偏態(tài)資料或未知分布類(lèi)型的資料可用非參數(shù)檢驗(yàn)法,比如秩和檢驗(yàn)等。最后按設(shè)計(jì)要求,統(tǒng)一制作CRF表：患者簽署知情同意書(shū),詳細(xì)記錄,認(rèn)真書(shū)寫(xiě)病例,注意觀察不良反應(yīng)或未預(yù)料的不良反應(yīng)。[結(jié)果]1、基線資料以就診時(shí)間順序編號(hào),根據(jù)隨機(jī)數(shù)字表法分成對(duì)照組、試驗(yàn)A組、試驗(yàn)B組、試驗(yàn)C組各37例,因在治療過(guò)程中試驗(yàn)A組脫落2例,試驗(yàn)B組脫落1例,試驗(yàn)C組脫落2例,實(shí)際例數(shù)對(duì)照組37例,試驗(yàn)A組35例,試驗(yàn)B組36例,試驗(yàn)C組35例。對(duì)照組身高(1.64±0.21)m,孕前體重(52.17±11.17) kg, BMI (20.67±10.05) kg/m2,平均年齡(28.53±8.49)歲；試驗(yàn)A組身高(1.66±0.27)m,孕前體重(53.65±12.05) kg, BMI (21.09±9.39) kg/m2,平均年齡(28.25±9.63)歲；試驗(yàn)B組身高(1.65±0.31)m,孕前體重(52.88±11.93) kg, BMI (20.93±9.57) kg/m2,平均年齡(29.13±8.67)歲；試驗(yàn)C組身高(1.66±0.19)m,孕前體重(53.97±12.41) kg, BMI (20.75±9.51) kg/m2,平均年齡(28.45±9.01)歲。2.治療前納入各組的空腹血糖,OGTT1h血糖、2h血糖,糖化血紅蛋白分別進(jìn)行成組t檢驗(yàn),各血糖和糖化血紅蛋白水平組問(wèn)比較,均是P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后各組患者血糖水平經(jīng)方差分析LSD-t檢驗(yàn),三試驗(yàn)組與對(duì)照組相比,各血糖水平差異有統(tǒng)計(jì)學(xué)意義(P0.05)；試驗(yàn)A組與試驗(yàn)B組相比,各血糖水平與之差異不明顯(P0.05)、試驗(yàn)A組與試驗(yàn)C組相比,各血糖水平差異有統(tǒng)計(jì)學(xué)意義(☆P0.05)；試驗(yàn)C組患者在空腹血糖,OGTT1h、2h,糖化血紅蛋白方面與其余三組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)3、經(jīng)過(guò)4個(gè)療程的治療,與對(duì)照組相比,三試驗(yàn)組在降低5-羥色胺水平方面有明顯差異,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；三試驗(yàn)組之間相比,也有統(tǒng)計(jì)學(xué)差異(P0.05)；4、三組試驗(yàn)組與對(duì)照組各項(xiàng)妊娠結(jié)局相比,除剖宮產(chǎn)幾率相似外,其余幾項(xiàng)都有明顯差異,有統(tǒng)計(jì)學(xué)意義(P0.05)；5、四組患者治療對(duì)血、尿、糞常規(guī)及肝、腎功能等方面均無(wú)明顯影響；6、使用胰島素治療的試驗(yàn)C組有4例患者出現(xiàn)水腫、蕁麻疹等不良反應(yīng)。[結(jié)論]胰島素對(duì)妊娠期糖尿病控制血糖方面療效確切,而心理干預(yù)治療也是效果顯著的治療方式之一；心理干預(yù)治療可使妊娠期糖尿病患者情緒穩(wěn)定,積極配合治療,從而改善患者血清5-羥色胺(5-HT)水平,達(dá)到協(xié)助控制血糖的治療目的；生活方式干預(yù)配合心理、胰島素的綜合治療,在血糖控制水平、降低糖化血紅蛋白水平,改善患者心理狀態(tài)、減少母嬰并發(fā)癥方面綜合效果最為顯著；心理干預(yù)治療方式的發(fā)生低血糖情況較少,無(wú)明顯不良反應(yīng)發(fā)生。心理干預(yù)治療方法或成為第三種輔助控制妊娠期糖尿病血糖的有效方法。
[Abstract]:[background] gestational diabetes refers to different levels of impaired glucose tolerance occurring during pregnancy or first found, excluding pre pregnancy diagnosed diabetes. The definition and diagnostic criteria for gestational diabetes are developed and perfected in the ongoing debate. According to epidemiological studies around the world, the incidence of gestational diabetes is shown. There are obvious differences among ethnic groups. Because there is no unified standard of diagnosis in the world, there is no unified standard of recommendation in China, and the constant changes of diagnostic standards. Therefore, the incidence of reports in various countries is very different. As 1%-14%, our domestic incidence is 1%-4% and the trend of increasing year by year. In view of the increasing incidence of gestational diabetes mellitus At present, the pathogenesis of gestational diabetes is not completely clear. According to the latest research progress, the pathogenesis of gestational diabetes may be related to genetic susceptibility, fat factor, chronic inflammatory reaction, obesity, transport of momentum, diet, pregnant women's age and psychosocial stress. Gestational diabetes can lead to a series of maternal and pregnancy complications, including: fetal macrosomia, chronic hypoxia in the uterus, abnormal fetal heart development, excessive amniotic fluid, premature rupture of membranes, premature birth, hypoglycemia, and so on. Only during the whole pregnancy, the control of maternal blood glucose to the normal range can improve pregnant women with gestational diabetes. The clinical treatment methods include diet therapy, exercise therapy, insulin use and so on. It is necessary to point out that insulin therapy must be based on dietary therapy, otherwise the effect is not satisfactory. Non drug therapy, such as diet and exercise, is an irreplaceable, effective, and major treatment method for gestational diabetes. There is a definite clinical effect in controlling blood sugar, reducing maternal and infant complications in perinatal period and reducing the dosage of insulin; oral hypoglycemic agents are controversial in the use of gestational diabetes because they may lead to teratoma, gigantic infants, neonatal hypoglycemia, and even death, and insulin is still used as gestational diabetes in our country. The only drug treatment, but the best treatment dose of insulin has no unified standard, the domestic and foreign scholars generally think that the dosage of insulin should be individualized, and the effect of placental hormone on insulin sensitivity with the progress of pregnancy is fully considered, and the dosage of insulin is adjusted in time. There is no denying that the most common effects of psychological stress on pregnant women are often overlooked. The high blood glucose level in gestational diabetes mellitus is characterized by higher postprandial hyperglycemia, fasting and nocturnal volume. It is easy to have hypoglycemia. Therefore, the choice of glycemic control regimen for gestational diabetes should ensure and provide the maternal body during pregnancy, the calorie and nutritional needs of the normal fetal development, avoid postprandial hyperglycemia or starvation ketosis, and control the blood sugar in normal programs. The level of blood sugar fluctuates greatly, thus increasing the difficulty of controlling blood sugar. Psychological adjustment helps to improve the mood of the pregnant women and reduce the melancholy. It is beneficial to the diet control and other treatment, which is beneficial to the regulation of blood sugar. Thus, the blood glucose control can be smoothly controlled and the hypoglycemia is prevented. A large number of cohort clinical studies have confirmed their therapeutic effects. Each of these factors is associated with the occurrence of gestational diabetes, but so far, any of these causes can not explain the pathogenesis of gestational diabetes alone. It may be the result of the interaction of these factors. Most scholars believe that the occurrence of the disease is a comprehensive analysis. In the study of the pathogenesis of gestational diabetes, the study of the pathogenesis of gestational diabetes, the study of psychosocial stress is obviously insufficient. In recent years, 5- hydroxytryptamine (5-HT) has been found to be directly or indirectly involved in psychological regulation. The study found that in the patients with gestational diabetes, the SCL-90 score is positively correlated with the level of serum 5-HT, suggesting that in pregnancy sugar In the patients with urinary disease, the change of 5-HT content is also an important link in the mental state of the patient, and it plays an important role in the assessment of psychological intervention. In the treatment, considering the particularity of the pregnancy period, after the diagnosis of gestational diabetes, the lifestyle intervention should be the main intervention, and the drug is still in poor control of blood sugar under the lifestyle intervention. The evaluation of the effect of psychological intervention is relatively inadequate. The existing research also has a lack of uniform diagnostic criteria, less sample content, a lack of unified and recognized symptoms of symptoms and evaluation criteria, limited observation time, lack of long-term follow-up, and no basic research as support, so it can not be clear. This study was based on the standards of pregnancy diabetes diagnosis promulgated and implemented in 2011 in China, and referring to the relevant provisions of the standard of diagnosis and treatment of gestational diabetes in 2013 of the American Diabetes Society, as a reference, comparing the three groups in the treatment of gestational diabetes, and observing the therapeutic effect of psychological intervention. [Objective]1, Observation of three methods of treatment of gestational diabetes in the treatment of gestational diabetes in reducing fasting blood glucose, OGTT 1H, 2h blood sugar, glycated hemoglobin and serum 5-HT content, improving the patient's condition, improving the long-term effect and so on, objectively evaluating its clinical effect, and 2, observing the effect of psychological intervention therapy on gestational diabetes, thus providing the clinical application. An effective treatment scheme. [method]1, all cases of this study were derived from the Department of Endocrinology, Department of Endocrinology, affiliated to Guangdong No.2 People's Hospital, Southern Medical University, from January 2013 to December 2013. Lower: diagnostic one step method: no need for 50g glucose load test (GCT), and the normal value of 75g glucose tolerance test (OGTT).75gOGTT at 24 weeks of pregnancy (OGTT): 1H, 2h, 2h, 2h,.75gOGTT, 2h, 1H, 2h, 1H, 2h, and 8.5mmol/L. of any abnormal glucose value should be diagnosed as gestational diabetes. The selected cases of diabetes were selected as subjects and were divided into 4 groups according to the sequence number of visiting time and according to the random digital table method. The control group was divided into 4 groups: the simple lifestyle intervention 37 cases, the test group A, the lifestyle intervention + insulin 37 cases, the test group B: the lifestyle intervention + psychological intervention 37 cases, the test C group: lifestyle intervention + heart group. Intervention + insulin group 37 cases of.2, treatment control group: simple lifestyle intervention patients take healthy publicity, exercise, diet guidance combined intervention treatment. Exercise with family upper limb exercise (30min daily, 3 times a day) and walk (every day 40min, after the meal after the 1H) combination, diet has a nutritionist special guidance, carbon hydration Material, protein, fat energy ratio is about 4:3:3. test A group: lifestyle intervention + insulin, patients on the basis of lifestyle intervention, add Insulin Aspart Injection Nohe, NovoRapidPenfill, produce batch number: CVG0519), subcutaneous injection before three meals a day, small dose of 1-2 units start, and then according to blood glucose monitoring, regulator Quantity. If the fasting blood sugar still does not reach the standard, when it is more than 5.3mmol/L, it is given a subcutaneous injection before bedtime with the addition of N, and the small dose begins with the blood glucose adjustment dose. Test B group: lifestyle intervention + psychological intervention and psychological intervention on the basis of lifestyle intervention. The specific method of psychological intervention is: a psychotherapist special person. It is responsible for the preaching of gestational diabetes, the explanation of the causes, the consequences and the preventive measures to make the patients fully aware of the great harm to pregnant and parturient women and perinatal infants. Patients with improper emotion and serious mental disorder were treated with appropriate behavioral cognitive therapy. Group C: lifestyle intervention + psychological intervention + insulin, patients were treated with insulin and psychological intervention under the intervention of lifestyle. Four groups of patients were treated, 2 weeks were observed and tested for a total of 4 courses, and four groups were carried out after the end of the course of treatment. To return to production.3, the observation indexes were compared between the three test group and the control group and the control group and the three test group, the fasting blood glucose, the 2 hour postprandial blood sugar, the fasting blood glucose after the end of the 4 course of treatment, the OGTT test 1H, the 2H blood sugar level, the change of glycated hemoglobin, the serum 5-HT content, the occurrence of hypoglycemia in the treatment process, the bad situation of mother and baby during the pregnancy, and receiving the bad situation of mother and baby during pregnancy, and taking the harvest. The data of the collection were statistically processed to compare the therapeutic effect of three ways of treating gestational diabetes.4. Statistical processing and the production of the CRF table were given to all the subjects to specify the possible benefits and risks involved in the clinical trials, to make the patients and their families fully informed and to sign the patients' consent and to sign the informed consent in writing; Design requirements, unified form, detailed record; carefully write the case observation table; all kinds of data are statistically processed. The questionnaire data are encoded and quantized into the computer, and the SPSS13.0 statistical analysis software is used. The prevalence rate is expressed as a percentage, the sample data is first normal test and variance homogeneity test. All data are used (x The test of P0.05 is statistically significant. For the normal distribution and the counting data of the same variance, the R x C table chi square (x 2) test, Ridit analysis, and the t test are used, and the data of the partial or unknown distribution can be used nonparametric test, such as the rank sum test, etc. Finally, according to the design requirements, the CRF is made to make the CRF unified. Table: patients signed informed consent, detailed records, carefully written cases, observed adverse reactions or unanticipated adverse reactions. [results]1, baseline data were numbered in order of time, divided into control group according to random digital table, test A, test B, group C, 37 cases each, because in the treatment process, the A group shedding 2 cases, test B 1 cases were shedding, 2 cases in group C, 37 cases in control group, 35 in group A, 36 in group B and 35 in group C. The control group was (1.64 +. 0.21) m, pre pregnancy weight (52.17 + 11.17) kg, BMI (20.67 + 10.05) kg/m2, and the average age was (28.53 +) m, before pregnancy weight (35) kg, BMI (+ + +) kg, BMI (+ + + +) 9.39) kg/m2, the average age (28.25 + 9.63) years, B group height (1.65 + 0.31) m, pre pregnancy weight (52.88 + 11.93) kg, BMI (20.93 + 9.57) kg/m2, average age (29.13 + 8.67) years; test C group height (1.66 + 0.19) m, pre pregnancy weight (53.97 + excluded) kg, BMI (52.88) kg/m2, average age (mean +) years of.2. before the treatment into each group before the treatment Fasting blood glucose, OGTT1h blood sugar, 2h blood sugar and glycated hemoglobin were divided into groups of t tests respectively. All blood sugar and glycated hemoglobin levels were compared, all were P0.05, and the difference was not statistically significant. After the treatment, the blood glucose level was analyzed by LSD-t test, and the difference of blood sugar levels between the three test group and the control group was statistically significant (P0. 05): compared with the test B group, the difference of blood glucose level was not obvious (P0.05), and the blood sugar levels of group A and C group were statistically significant (P0.05), and the difference in fasting blood glucose, OGTT1h, 2h and glycated hemoglobin in the C group was statistically significant (P0.05) 3, after 4 courses of treatment (P0.05) 3. Compared with the control group, compared with the control group, there was a significant difference in the level of 5- serotonin in the three test group, and the difference was statistically significant (P0.05). Compared with the three test groups, there were also statistical differences (P0.05); 4, the three groups were significantly different from the control group, except for the cesarean section. P0.05; 5, four groups of patients had no significant effect on blood, urine, faecal routine and liver and kidney function; 6, using insulin.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R714.256

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 崔璐;張愛(ài)珍;;肥胖妊娠期婦女的糖耐量減低與糖尿病[J];國(guó)際婦產(chǎn)科學(xué)雜志;2008年01期

2 揭金花;許榕仙;;妊娠期糖尿病發(fā)病機(jī)制及對(duì)母嬰的影響[J];國(guó)際婦產(chǎn)科學(xué)雜志;2011年03期

3 崔占葉;崔付清;馬英霞;;社區(qū)個(gè)體化綜合干預(yù)妊娠期糖尿病孕婦的研究[J];臨床醫(yī)學(xué);2013年03期

4 王建芳;游錦萍;;妊娠期糖尿病患者心理健康狀況相關(guān)因素的調(diào)查[J];中國(guó)現(xiàn)代醫(yī)生;2012年15期

，

本文編號(hào)：2082621