【作者】 杨卉；

【导师】 黄金；

【作者基本信息】 中南大学 ， 护理学， 2009， 硕士

【摘要】 目的:1.评估妊娠期糖尿病(gestational diabetesmellitus,GDM)在产科住院病人中的患病率。2.评价GDM对妊娠结局的影响。3.探讨GDM的危险因素及其对GDM的影响程度。方法:本研究选择2004年1月至2008年12月在中南大学湘雅二医院产科住院分娩的妊娠期糖尿病患者235例,随机选择同期住院分娩的非GDM孕妇261例作为对照组。记录两组孕妇的一般特征及糖尿病家族史、孕产史、妊娠合并症、孕前体重指数、孕期体重增长、羊水指数、出血量、分娩方式及新生儿评分、新生儿体重、新生儿并发症及预后,分析GDM的危险因素及对妊娠结局的影响。采用SPSS16.0统计软件对资料进行描述性分析、两样本t检验、单因素方差分析、x~2检验、U检验、非条件Logistic回归分析。结果:1.产科住院病人中,GDM患者患病率为4.24%,且呈逐年上升趋势。2.两组在孕产史的比较上显示孕次、流产次数、早产次数、足月产次数、存活数及胎次的比较有统计学意义(P＜0.01)。3.两组在产后出血量、住院费用、孕产妇及新生儿住院天数的比较中,GDM组大于对照组;而新生儿体重、新生儿Apgar评分GDM组均低于对照组。两组在妊娠结局的比较中,GDM组发生剖宫产、早产及新生儿窒息、新生儿肺炎、新生儿缺血缺氧性脑病、巨大儿、低体重儿、新生儿入新生儿监护室(NCU)治疗及围产儿死亡率均高于对照组,上述比较均具有统计学意义(P＜0.01),GDM组与对照组在新生儿黄疸的组间比较中差异无统计学意义(P＞0.05)。4.非条件logistic回归分析结果表明,影响GDM的因素依次为:胎次、家族史、体重指数、产次、体重增长、年龄、文化程度,各影响因素回归系数分别为:2.384、2.068、1.087、1.007、0.709、0.455、-0.209。结论:1.GDM在住院孕产妇中患病率为4.24%,且呈逐年上升趋势。2.与非GDM孕妇相比,GDM孕妇产后出血量、羊水过多或过少、剖宫产率及产后并发症发生率高,住院日及住院费用增加;排除年龄的影响,GDM孕妇产后出血发生率高。3.GDM孕妇巨大儿、低体重儿、早产、新生儿窒息、围产儿死亡、新生儿NICU监护、新生儿肺炎、HIE的发生率高于非GDM孕妇,但新生儿黄疸无明显差异。4.胎次、家族史、体重指数、产次、体重增长、年龄、文化程度是GDM的危险因素。更多还原

【Abstract】 Objective: To investigate the incidence of gestational diabetes mellitus(GDM) in in-patient and the influence on pregnancy outcome of GDM, and explore the associated factors and the extent of their influences on GDM.Methods: A random sampling method was used in this study. 235 GDM women were investigated from January, 2004 to December, 2008 who deliveryed in the Xiangya Second Hospital of central south University, and 261 without GDM women who are synchronization childbirth used as control .We analysis on general character of two group and the effect between the mobility of GDM and every factor such as family history with DM, child-bearing history, pregnancy complication, baseline body mass index(BMI), duration weight gain of pregnancy, amniotic fluid index(AFI), postpartum blood loss, delivery mode, and the Apgar score, complication, prognosis of neonate. The Statistical Package for Social Science (SPSS) 16.0was used for the descriptive analysis of ANOVA, t-test, chi-square, U test, Logistic stepwise regression.Results:1. The incidence of gestational diabetes mellitus(GDM) in in-patient was 4. 24 percent and the trend is raising by years.2. The results of 2 samples t-test on child-bearing history showed that the times of pregnancy, abortion, premature delivery, term delivery, twin pregnancy and survival rat were of statistical significance between the GDM group and the control group (P<0.01) .3. The analysis of the postpartum blood loss, the fare of cure, the Average Length of Stay in GDM group were significantly higher than control group and the neonatal weight, Apgar score were lower in GDM group. The results of Chi-square on GDM and control group indicated that the women of GDM has higher rate of ceasarean , premature delivery, neonatal leipothymia, neonatal pneumonia , hypoxic-ischemic encephalopathy, neonatal macrosomia, low-birth-weight infant than control group (P<0.001). But the neonatual jaundice between GDM and control group has not statistical significance (P>0.05) .4. The results of logistic regression analysis indicated that twin pregnancies, family history, baseline BMI, times of delivery, duration weight gain of pregnancy, age, education were the main factors related to GDM. Their logistic coefficients were 2.384、2.068、1.087、1.007、0.709、0.455、-0.209 respectively. Among them, the most influencing factor was twin pregnancies.Conclusions:1 .The incidence of gestational diabetes mellitus(GDM) in in-patient was 4.24 percent and the trend is raising by years.2.Women with GDM had more postpartum blood loss and had a high frequency of polyhydramnios, oligohydramnios, cesarean section, complications and increased fare of cure and the average length of stay compared with women without GDM.3. Women with GDM had high risk of neonatal macrosomia, low-birth-weight infant, premature delivery, neonatal leipothymia, perinatal mortality, neonate in NICU, neonatal pneumonia , hypoxic-ischemic encephalopathy compared with women without GDM, But the neonatual jaundice between GDM and control group has not statistical significance.4. The main influencing factors of GDM were twin pregnancies, family history, baseline BMI, times of delivery, duration weight gain of pregnancy, age, education.更多还原