• 四川大學華西第二醫(yī)院婦產科（成都610041）;

目的 　查找循證醫(yī)學證據，為1例妊娠期糖尿病患者制定合理的治療方案。
方法 　針對患者的臨床問題，以妊娠期糖尿病、二甲雙胍等為檢索詞，電子檢索ACP Journal Club（1991～2006.12）、 Cochrane圖書館（2006年第4期）、MEDLINE（1966～2006.12）和中國生物醫(yī)學文獻數據庫（1980～2006.12），查找相關的系統(tǒng)評價、隨機對照試驗等，并對所獲證據進行質量評價。
結果 　從MEDLINE 檢索到Meta分析1篇（2006年），從Cochrane臨床試驗中心登記庫查到臨床對照試驗2篇，其結果提示二甲雙胍可降低妊娠期糖尿病圍產期并發(fā)癥的發(fā)生率，但尚無證據證明其是否會導致胎兒畸性。由于所納入試驗的樣本量較小，還需要高質量、大規(guī)模臨床隨機對照試驗來證實。據此，我們結合醫(yī)生經驗及患者意愿，對該患者不采用口服二甲雙胍治療，而是通過嚴格飲食控制及血糖檢測，結合適量運動。妊娠期間，患者體重增長平穩(wěn)，胎兒監(jiān)護反應良好，于孕39+4周自然分娩一足月健康女嬰。結論 　我們運用循證醫(yī)學證據為該例妊娠期糖尿病患者選擇了安全、合理的治療方案。口服降糖藥二甲雙胍對妊娠期糖尿病患者的有效性和安全性尚需高質量、大樣本的隨機對照試驗證實。

引用本文： 張榮,邢愛耘. 1例妊娠期糖尿病患者的循證治療. 中國循證醫(yī)學雜志, 2007, 07(8): 614-617. doi: 復制

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  2. 2. Zhao RL. The Efficiency and Safty of Metformin used in Pregnancy women. Chin J Perinat Med, 2005, 8(5): 299.
  3. 3. 樂杰, 主編. 婦產科學. 第6版. 北京: 人民衛(wèi)生出版社, 2004: 159-162.
  4. 4. 趙瑞琳. 二甲雙胍治療糖尿病孕婦的療效及安全性——2005年美國糖尿病學會年會專題討論側記. 中華圍產醫(yī)學雜志, 2005, 8(5): 299.
  5. 5. Guyatt GH, Rennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press, 2002.
  6. 6. Gilbert C, Valois M, Koren G, et al. Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis. Fertil Steril, 2006, 86(3): 658-663.
  7. 7. Vanky E, Salvesen KA, Heimstad R, et al. Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women: results of a randomized study. Hum Reprod, 2004, 19(8): 1734-1740.
  8. 8. Glueck CJ, Goldenberg N, Pranikoff J, et al. Height,weight,and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod, 2004, 19(6): 1 323-1 330.
  9. 9. Simmons D, Waiters BN, Rowan JA, et al. Metformin therapy and diabetes in pregnancy. Med J, 2004, 180: 462-464.