• 四川大學(xué)華西第二醫(yī)院婦產(chǎn)科（成都610041）;

目的 　查找循證醫(yī)學(xué)證據(jù)，為1例妊娠期糖尿病患者制定合理的治療方案。
方法 　針對(duì)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(xué)文獻(xiàn)數(shù)據(jù)庫（1980～2006.12），查找相關(guān)的系統(tǒng)評(píng)價(jià)、隨機(jī)對(duì)照試驗(yàn)等，并對(duì)所獲證據(jù)進(jìn)行質(zhì)量評(píng)價(jià)。
結(jié)果 　從MEDLINE 檢索到Meta分析1篇（2006年），從Cochrane臨床試驗(yàn)中心登記庫查到臨床對(duì)照試驗(yàn)2篇，其結(jié)果提示二甲雙胍可降低妊娠期糖尿病圍產(chǎn)期并發(fā)癥的發(fā)生率，但尚無證據(jù)證明其是否會(huì)導(dǎo)致胎兒畸性。由于所納入試驗(yàn)的樣本量較小，還需要高質(zhì)量、大規(guī)模臨床隨機(jī)對(duì)照試驗(yàn)來證實(shí)。據(jù)此，我們結(jié)合醫(yī)生經(jīng)驗(yàn)及患者意愿，對(duì)該患者不采用口服二甲雙胍治療，而是通過嚴(yán)格飲食控制及血糖檢測(cè)，結(jié)合適量運(yùn)動(dòng)。妊娠期間，患者體重增長(zhǎng)平穩(wěn)，胎兒監(jiān)護(hù)反應(yīng)良好，于孕39+4周自然分娩一足月健康女嬰。結(jié)論 　我們運(yùn)用循證醫(yī)學(xué)證據(jù)為該例妊娠期糖尿病患者選擇了安全、合理的治療方案?？诜堤撬幎纂p胍對(duì)妊娠期糖尿病患者的有效性和安全性尚需高質(zhì)量、大樣本的隨機(jī)對(duì)照試驗(yàn)證實(shí)。

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(xué)雜志, 2007, 07(8): 614-617. doi: 復(fù)制

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  1. 1. Yue J, Editor-in-chief. Obstetrics and Gynecology. 6th ed. Beijing: People’s Medical Publishing House, 2004: 159-162.
  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(chǎn)科學(xué). 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(xué)會(huì)年會(huì)專題討論側(cè)記. 中華圍產(chǎn)醫(yī)學(xué)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.