妊娠合并酮症酸中毒

妊娠合并酮症酸中毒是一种可危及孕妇与胎儿生命的严重并发症,由于妊娠期的生理改变,发生酮症的易感性增加。本文主要阐述了妊娠期发生酮症酸中毒的发生机制、诱因、对母儿的风险及处理。     

糖尿病合并妊娠伴视网膜病变孕妇的临床观察

目的：研究糖尿病合并妊娠伴视网膜病变孕妇的妊娠结局及孕期视网膜病变。方法：回顾性分析１９８１～１９９５年间４９例糖尿病孕妇妊娠情况。伴视网膜病变的１６例分为第Ⅰ组；无视网膜病变的３３例分为第Ⅱ组。第Ⅰ组糖尿病病程平均为８．９２±４．３５年；第Ⅱ组为３．１１±１．７４年。结果：第Ⅰ组孕妇并发症及围产儿发病率较高，但两组比较，差异无显著性（Ｐ＞０．０５）。３１．１％孕妇视网膜病变在孕期加重，但仍属单纯型（背景期）。结论：糖尿病合并妊娠伴眼底病变时，仍可以继续妊娠，但孕期应密切观察眼底变化和严格控制血糖。     

Sonographic Measurement of Umbilical Vein and Umbilical Cord Diameters in Normal and Diabetic Pregnancies

Sonographic visualization of umbilical cord components is becoming increasingly important in evaluating fetal well-being. Standard graphs of umbilical vein and cord measurements during the last two trimesters of 219 normal singleton pregnancies showed a linear increase in transverse dimensions with advancing gestational age. Preliminary data on 38 pregnancies complicated by maternal diabetes mellitus, showed significant deviations from normal umbilical measurements.     

Reversal of diabetic related accelerated fetal growth by maternal glycaemic control

In a young woman with insulin-dependent diabetes mellitus, poor diabetic control during the second trimester of pregnancy resulted in ketoacidosis, accelerated fetal growth and polyhydramnios. With the establishment of tight maternal glycaemic control, both accelerated intrauterine growth and polyhydramnios were reversed and a good pregnancy outcome resulted.     

糖尿病酮症酸中毒的治疗体会

目的:探讨糖尿病酮症酸中毒的治疗。方法:对21例糖尿病酮症酸中毒患者的临床资料进行回顾性分析。结果:呼吸道感染为其主要的诱因。经积极治疗后,21例糖尿病酮症酸中毒患者均痊愈出院。结论:早期诊断,正确治疗,去除诱因,保护多脏器功能,是抢救糖尿病酮症酸中毒成功的关键。     

Are birth weight predictors in diabetic pregnancy the same in boys and girls?

Objectives

To study the predictors of abnormal fetal growth in diabetic pregnancy, analyzing the role of fetal sex.

Study design

Observational retrospective study was carried out in a University hospital. We studied 2833 newborns of diabetic mothers who attended the Diabetes and Pregnancy Clinic and delivered in the center between 1/1/1982 and 31/12/2006 (2370 born to women with gestational diabetes mellitus, 391 to women with type 1 diabetes mellitus (DM), and 72 to women with type 2 DM). Logistic regression analyses were performed with a backward method to predict large for gestational age (LGA), small for gestational age (SGA) and macrosomic newborns using relevant variables and their interaction with fetal sex. We have used as potential predictors of abnormal birth weight: maternal prepregnancy age, weight, height and body mass index, prior pregnancy, prior macrosomia, smoking habit, weight increase during pregnancy, hypertension, gestational age at delivery, twin pregnancy, fetal sex, diabetes type, third trimester HbA1c and interaction of fetal sex with all these variables.

Results

Variables predictive of LGA, SGA and macrosomia were as formerly described. Moreover, some predictors of abnormal growth displayed an interaction with fetal sex. In LGA prediction, male sex displayed a positive interaction with delivery week, prior gestation, diabetes type and twin pregnancy and a negative one with weight increase. In SGA prediction, male sex displayed a positive interaction with delivery week and diabetes type. In macrosomia prediction, male sex displayed a negative interaction with weight increase.

Conclusions

In this cohort of diabetic pregnancies, some predictors of abnormal birth weight display interaction with fetal sex. In general, associations were more favorable to female fetuses.     

Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial

OBJECTIVE: This study was undertaken to compare preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes. STUDY DESIGN: Sixty-one women with type 1 diabetes were randomly assigned at 16 weeks' gestation to preprandial or postprandial blood glucose monitoring using memory-based glucose reflectance meters throughout pregnancy. Serial measurements of hemoglobin A1c and fructosamine were obtained throughout pregnancy. Insulin, glucose, and insulin-like growth factor-I (IGF-I) were measured in cord blood at delivery. Neonatal anthropometric measures were performed within 72 hours of delivery RESULTS: Maternal age, parity, age of onset of diabetes, number of prior miscarriages, smoking status, social class, weight gain in pregnancy, and compliance with therapy were similar in the two groups. The postprandial monitoring group had a significantly reduced incidence of preeclampsia (3% vs 21%, P<.048), a greater success in achieving glycemic control targets (55% vs 30%, P<.001) and a smaller neonatal triceps skinfold thickness (4.5+/-0.9 vs 5.1+/-1.3, P=.05). CONCLUSION: Postprandial capillary blood glucose monitoring in type 1 diabetic pregnancy may significantly reduce the incidence of preeclampsia and neonatal triceps skinfold thickness compared with preprandial monitoring.     

妊娠合并糖尿病酮症酸中毒的识别和处理

妊娠合并糖尿病酮症酸中毒是产科严重的合并症,如未能及时诊断及处理,会造成母儿严重的不良结局。本文就妊娠合并DKA的临床识别及处理进行讨论。     

Aberrant patterns of cellular communication in diabetes-induced embryopathy in rats: II, apoptotic pathways

OBJECTIVE: The objective was to test the hypothesis that hyperglycemia-induced injury of yolk sac cell membranes is associated with disruption of cellular apoptotic signaling pathways. STUDY DESIGN: Pregnant rats were induced to become diabetic by injection of streptozotocin. Fourteen normal control and 24 diabetic rats were killed on day 12 of gestation. Yolk sac membranes in 3 conceptus groups (nondiabetic, diabetic with normal, or diabetic with malformed conceptus) were collected for study. DNA was extracted from yolk sac cells and assayed for fragmentation by using gel electrophoresis, which indicates apoptosis. Protein expression was evaluated by Western blot assays. Statistical analyses were performed with the Student t -test. RESULTS: The level of phosphorylated Akt was significantly decreased, whereas that of the proapoptotic protein Bax was increased. These changes were correlated with the presence of DNA fragmentation in yolk sac cells of the diabetic malformed conceptuses. CONCLUSION: Hyperglycemia-induced embryopathy involves apoptosis, during which the expression of proapoptotic protein Bax is upregulated and the activity of the cell-survival factor, Akt kinase, is decreased in yolk sac cells. These observations suggest that hyperglycemia of maternal diabetes triggers apoptotic signaling pathways and inhibits cell survival pathways, leading to embryonic malformations.     

糖肾安复方治疗糖尿病肾病疗效观察

目的：观察糖肾安复方治疗脾肾阳虚型糖尿病肾病的临床效果。方法：采用随机平行对照方法,选取我科住院及门诊60例糖尿病肾病患者,按随机数字表随机分为治疗组和对照组各30例。两组在常规降糖基础上,对照组给予贝那普利lOmgl次／日口服治疗;治疗组予糖肾安复方125ml2次／日治疗,疗程8周,观察两组实验室指标的变化。结果：治疗8周后,对照组总有效率60％,治疗组总有效率83．3％;两组比较,差异显著（P〈0．05）。两组实验室指标均有所改善（P=0．0113〈0．05）,但试验组优于对照组（P=0．0172〈0．05）。结论：糖肾安复方对糖尿病肾病有较好的临床疗效。     

Effectiveness of honey dressing in the treatment of diabetic foot ulcers: A systematic review and meta-analysis

ObjectiveHoney dressing has been applied in the treatment of diabetic foot ulcers (DFUs). However, there is a lack of research showing ample evidence that honey dressing is more effective in the treatment of DFUs than other dressings. This study aimed to examine the effects of honey dressing on wound-healing process for DFUs.MethodWe searched for evidence regarding honey dressing used in the treatment of DFUs in various databases. We selected randomized controlled trials (RCTs) and quasi-experimental studies for meta-analysis.ResultsThe meta-analysis showed that honey dressing effectively shortened the wound debridement time, wound healing time, and bacterial clearance time; it increased the wound healing rate and bacterial clearance rate during the first one to two weeks of use.ConclusionOur findings suggest that honey dressing effectively promotes healing in DFUs. Further research is needed to elucidate these findings so that this form of treatment can be widely applied.     

食物血糖生成指数在妊娠期糖尿病营养教育中的应用

目的　通过营养健康教育,观察妊娠期糖尿病(gestatinoal diabetes mellitus,GDM)患者对食物血糖生成指数(glycemic index,GI)的接受程度、饮食行为改变,以及对血糖、母婴并发症发生率的影响. 方法　选择72例GDM患者作为研究对象,随机分为2组,实验组以食物GI为主要教育材料;对照组以食物交换份作为主要教育材料,采用集体讲座3次、随时电话咨询、当面答疑等方式教育至患者分娩前,观察教育前后研究对象对所授知识的接受程度、饮食行为改变、血糖变化、母儿并发症发生率. 结果 经过营养健康教育,GDM患者一致认为饮食治疗是控制血糖的首要基础,实验组接受教育后在选择食物方面,每餐选择低GI食物的百分率由13.8%提高到83.3%(P<0.01),实验组教育后三餐食物GI分别为56.1±3.5,64.2±3.3,62.7±3.1,均较教育前明显下降(P<0.01).实验组和对照组教育后空腹血糖分别为(6.3±0.6)mmol/L,(7.6±1.3)mmol/L、餐后2 h血糖分别为(7.2±0.9)mmol/L,(9.7±1.2)mmol/L,均较教育前有显著性下降[(空腹血糖:(9.2±1.6)mmol/L和(9.6±1.5)mmo/L;餐后2 h:(11.1±1.6)mmol/L和(10.6±1.2)mmol/L,P<0.01)],但实验组血糖控制更理想.实验组手术产率为58.3%(23/36)、巨大儿出生率为2.7%(1/36)、胎儿窘迫发生率为5.5%(2/36),均低于对照组(分别为28、5、9例P<0.05). 结论 营养健康教育是控制血糖的有效手段;用食物GI知识来选择食物比用食物交换份法更容易控制血糖,效果更为理想,便于在医院门诊和社区教育中广泛推广和应用;建议可将食物GI与食物交换份相结合指导GDM患者更科学、更合理的安排每日膳食.     

妊娠合并糖尿病酮症酸中毒12例临床分析

目的:探讨妊娠合并糖尿病酮症酸中毒(DKA)的临床特征。方法:回顾性分析本院收治的资料完整的妊娠合并DKA 12例患者的临床特征和母儿结局。结果:本组妊娠合并DKA发病率0.36‰;发生在孕早期1例(8.3%)、孕中期2例(16.7%)、孕晚期9例(75.0%);孕前糖尿病(PGDM)8例(66.7%),妊娠期糖尿病(GDM)4例(33.3%)。12例均为单胎自然妊娠、均未进行孕前咨询及正规产检,有不良孕产史4例,孕前超重4例,既往血糖升高史1例,糖尿病家族史1例。12例均未规范产检且胰岛素用量不足;感染5例(41.7%),重度子痫前期3例(25.0%),地塞米松诱发2例(16.6%),先兆临产应激2例(16.6%),饮食不当1例(8.3%)。实验室检查,p H值7.050~7.319,BE-11.6~-28.8,平均血糖20.91±6.13 mmol/L,平均血酮体3.06±1.44 mmol/L,平均糖化血红蛋白(Hb A1c)为(9.04±2.09)%,10例患者尿糖阳性,12例患者尿酮体均为阳性,且均存在不同程度的电解质紊乱。12例患者均在4~8小时内成功酮体转阴,血糖控制达标。入院前就发生死胎者3例,难免流产1例;入院后仅8例继续妊娠,其中4例因妊娠合并症在DKA纠正后的1~3天终止妊娠,4例妊娠足月分娩,8例新生儿均存活。结论:妊娠合并DKA的发病率随孕周的增加而增加,PGDM比GDM者更易发生;患者存在不同程度的内环境紊乱及胰岛素使用不规范和感染。高危妇女应规范筛查并积极诊治糖尿病,早期识别并规范处置DKA,可获得良好的母儿预后。     

The correlations of glycosylated serum protein and glycosylated hemoglobin concentrations with blood glucose in diabetic pregnancy

The usefulness of concentrations of glycosylated serum protein and glycosylated hemoglobin in monitoring glycemic control during pregnancy complicated by diabetes was evaluated by correlation of these parameters with fasting and 2-hour postprandial glucose concentrations of the previous 7 days. Glycosylated serum protein correlated with both fasting (r = 0.798, p less than 0.01, n = 71) and postprandial (r = 0.846, p less than 0.01, n = 69) blood glucose concentrations. Glycosylated hemoglobin also correlated with fasting (r = 0.571, p less than 0.01, n = 71) and postprandial (r = 0.510, p less than 0.01, n = 74) blood glucose concentrations. Monitoring glycosylated serum protein during pregnancy complicated by diabetes is clinically feasible and allows frequent reappraisal of diabetic control.