Lean M E, Pearson D W, Sutherland H W
Combined Diabetic Antenatal Clinic, Aberdeen Maternity Hospital, UK.
Diabet Med. 1990 Feb;7(2):162-4. doi: 10.1111/j.1464-5491.1990.tb01352.x.
A standardized intravenous regimen has been assessed, in 25 insulin-treated diabetic women, for insulin and dextrose therapy in labour and delivery. Adjustments to insulin infusion rate are determined by trends in blood glucose as well as by absolute concentration, in order to approach normoglycaemia. Blood glucose was 5.0 (SD 1.7) mmol l-1 on arrival in labour (or at 0800 h before planned delivery) and was maintained at 6.0 (SD 1.8) mmol l-1 with insulin 0-5 U h-1 for up to 29 h before delivery, when it was 6.3 (SD 2.1, range 3.0-9.0) mmol l-1 with insulin infusion rate 0-4 U h-1. Neonatal blood glucose (less than 2.0 mmol l-1 in 11 babies) correlated with both maternal HbA1c (rs = -0.47, p less than 0.02) and maternal blood glucose at delivery (rs = -0.58, p less than 0.01). During 12 months observation on the intravenous regimen, 339 measurements of blood glucose were made; 10 were less than 3.0 mmol l-1, 242 were 3.0-8.0 mmol l-1, and 81 were greater than 8.0 mmol l-1 (mean 6.5, range 2.7-13.5 mmol l-1). Insulin infusion rate ranged from 0 to 5 U h-1, with 139 rate adjustments. Only one mild clinical hypoglycaemic episode, responding to increased dextrose infusion, was recorded. This simple flexible regimen proved clinically reliable for both midwifery and medical staff.
在25名接受胰岛素治疗的糖尿病孕妇中，评估了一种标准化静脉给药方案用于分娩时胰岛素和葡萄糖治疗的情况。根据血糖变化趋势以及绝对浓度来调整胰岛素输注速率，以实现血糖正常化。产妇分娩时（或计划分娩前08:00时）血糖为5.0（标准差1.7）mmol/L，在分娩前长达29小时内，使用0 - 5 U/h的胰岛素将血糖维持在6.0（标准差1.8）mmol/L，分娩时血糖为6.3（标准差2.1，范围3.0 - 9.0）mmol/L，胰岛素输注速率为0 - 4 U/h。新生儿血糖（11名婴儿低于2.0 mmol/L）与母亲糖化血红蛋白（rs = -0.47，p < 0.02）以及母亲分娩时血糖（rs = -0.58，p < 0.01）均相关。在对该静脉给药方案进行12个月的观察期间，共进行了339次血糖测量；10次低于3.0 mmol/L，242次在3.0 - 8.0 mmol/L之间，81次高于8.0 mmol/L（平均6.5，范围2.7 - 13.5 mmol/L）。胰岛素输注速率范围为0至5 U/h，共进行了139次速率调整。仅记录到1次轻度临床低血糖发作，通过增加葡萄糖输注得到缓解。这种简单灵活的方案在临床实践中对助产士和医务人员而言都被证明是可靠的。
