糖尿病对中国和刚果巨大儿孕产妇影响的分析

发布时间：2018-03-06 10:32

本文选题：巨大儿　切入点：妊娠期糖尿病　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的-探讨妊娠期糖尿病(GDM)的巨大儿孕产妇和非GDM的巨大儿孕产妇的产科临床表现之间的差异。-观察中国和刚果巨大儿孕产妇之间的产科临床表现之间的差异。-探讨中国和刚果巨大儿分娩对母体的影响的差异。-确定GDM对巨大儿的影响(包括新生儿低血糖、头颅血肿、颅脑出血、臂丛神经损伤,围产期新生儿死亡率等)。-研究中国(GDM和非GDM母亲)和刚果金(GDM和非GDM母亲)巨大儿发生和结果之间的相关因素的差异性。-探讨提出一些更好的控制巨大儿产生的策略和应对措施。研究方法这是一项回顾性比较研究,收集自2014年1月至2015年12月,在University hospital诊所和Don Bosco诊所(卢本巴希/刚果)以及济南市中心医院(济南/中国)分娩的巨大儿的孕产妇资料。产妇数据从分娩登记册获得。收集的孕产妇信息包括年龄,产次,巨大儿妊娠史和GDM。分娩方式(剖宫产分娩或阴道分娩)。收集的新生儿信息是婴儿的体重,婴儿的性别,头围,在1分钟,在5分钟和在10分钟的新生儿阿普加评分。研究的产妇并发症有会阴裂伤,产后出血,感染,子宫破裂,新生儿并发症有低血糖,头颅血肿,神经损伤(臂丛神经麻痹)以及胎儿是否存活或死亡(围产期死亡率)。使用SPSS软件17.00版进行分析。结果研究包括取自University hospital诊所和Don Bosco诊所(刚果)的87名分娩巨大儿的女性(平均年龄:32.73 51±5.16);32名分娩巨大儿的中国女性(平均年龄:30.47±3.784)取自济南市中心医院。在刚果组有54%是GDM孕妇,在中国组中为62.5%。在我们的研究中,产次4的孕妇人数在刚果组(52.9%)中很高。剖宫产率在刚果妇女中低(29%),而在中国妇女中高(75%)(X2 = 7.675,P0.001)。我们的研究还显示,刚果中的52.8%的巨大儿是男婴,而中国组的53.1%的巨大儿是男婴,刚果巨大儿和中国巨大儿的体重平均值分别为(4194.22± 164.945)gr和(4523.53±423.142)gr。在刚果,GDM母亲所生巨大儿的平均体重要比非GDM母亲所生巨大儿的要重,P值为0.001;但来自GDM母亲和非GDM母亲的巨大儿的头围差异并不显著。来自GDM和非GDM母亲的中国巨大儿的平均出生体重和头围的比较是没有统计学意义的(P0.05)。然而,比较来自刚果组和中国组的两组巨大儿(GDM和非GDM)的1分钟,5分钟和10分钟新生儿阿普加评分,得出结论:来自非GDM母亲的巨大儿的平均阿普加新生儿评分要高于来自GDM母亲的巨大儿(P0.001)。这项研究还显示GDM在新生儿中会导致低血糖,刚果巨大儿中GDM和低血糖之间的关联有显著的统计学差异(X2 = 4.252;P= 0.001),但是不论刚果还是中国组,其他胎儿并发症(产瘤,围产期死亡率和臂丛神经损伤)与GDM均是没有相关性的(P0.05)。这项研究显示,只有一名刚果妇女(1.1%)在分娩后有感染,11名刚果妇女(12.6%)并发产后出血,一名刚果妇女(1.1%)发生子宫破裂。在经阴分娩的刚果妇女中,有19例(21.9%)有会阴裂伤,结果显示会阴裂伤和阴道分娩之间有明显的相关性(X2 =7.675和P0.001)。然而,没有中国妇女发生产后出血,感染或子宫破裂。在阴道分娩的中国妇女中,只有2例(25%)有会阴裂伤,但与刚果有会阴裂伤的相比无统计学意义(P 值0.05)。结论GDM与巨大胎儿明显相关,并且可诱发一些并发症,例如新生儿阿普加低评分,低血糖,大头围和新生儿体重增加,这也诱发一些产妇并发症,例如阴道分娩时产妇的会阴裂伤。种族(中国人或刚果人)和婴儿的性别应被认为是影响巨大儿体重的因素。中国巨大儿的体重超过刚果巨大儿的,男婴在两组人群中的体重都超过了女婴。对有巨大儿倾向的孕妇应该给予更好管理,可根据临床和/或超声指导,从而给予孕产妇先进的分娩诱导和选择性的剖腹产。应通过加强对孕期摄入葡萄糖的控制来降低新生儿发生低血糖的风险。应该加强妇产科医生,儿科医生和营养师的合作,以尽量减少产妇和胎儿的不良后果。
[Abstract]:Study objective to investigate gestational diabetes mellitus (GDM) clinical manifestations of macrosomia difference between obstetric maternal maternal fetal macrosomia and non GDM. The observed differences between obstetric clinical manifestations between Chinese and macrosomia in Congo. To explore the influence of China and Congo macrosomia delivery to the mother. To determine the effect of GDM on the great the children (including neonatal hypoglycemia, brain hematoma, cerebral hemorrhage, brachial plexus injury, perioperative mortality of neonatal perinatal research (GDM) - China and non GDM mother) and Congo (GDM and non GDM mother). - differences between related factors of macrosomia and the results of the study and put forward strategies and measures of great some better control. Methods this is a retrospective comparative study, collected from January 2014 to December 2015, University hospital and Don Bosco in clinic clinic (Lu Benba Hope / Congo Central Hospital of Ji'nan (Ji'nan) and / China) macrosomia delivery of maternal maternal data. Data from the birth register. The collected information including maternal age, parity, mode of delivery and the history of GDM. macrosomia (pregnancy cesarean section or vaginal delivery). The collected information is the newborn baby the baby's gender, body weight, head circumference, in 1 minutes, 5 minutes and 10 minutes in the neonatal Apgar score. Maternal complications study have perineal laceration, postpartum hemorrhage, infection, uterine rupture, neonatal complications have hypoglycemia, head hematoma, nerve injury (brachial plexus palsy) and fetal survival or death (perinatal mortality). The 17 edition were analyzed by using SPSS software. The results of University and Don from the hospital clinic including Bosco clinic (Congo) 87 macrosomia women (mean age: 32.7351 + 5.16); 32 Name of macrosomia China women (mean age: 30.47 + 3.784) from the Ji'nan Central Hospital in Congo. There are 54% group GDM in pregnant women, Chinese group for 62.5%. in our study, 4 pregnant women in the number of births in Congo group (52.9%) is high. The rate of cesarean section in Congo women low (29%), and in Chinese women high (75%) (X2 = 7.675, P0.001). Our research also showed that, in the 52.8% Congo macrosomia infant macrosomia, and Chinese group 53.1% is male, Congo macrosomia and China macrosomia weight respectively (4194.22 + 164.945) GR and (4523.53 + 423.142) gr. in Congo, the average weight of macrosomia born GDM mother to macrosomia born mother heavier than non GDM, P value is 0.001; but no significant difference from the mother and head circumference GDM GDM non macrosomia mother. The average macrosomia from Chinese GDM and non GDM mother Birth weight and head circumference comparison was not statistically significant (P0.05). However, compared two groups of macrosomia from Congo group and China group (GDM and GDM) 1 minutes, 5 minutes and 10 minutes of neonatal Apgar score. Conclusion: macrosomia from non GDM mother's average Apgar Apgar score is higher than that of macrosomia from GDM mother (P0.001). This study also showed that GDM can cause hypoglycemia in the neonatal macrosomia in Congo, the association between GDM and hypoglycemia have statistically significant difference (X2 = 4.252; P= 0.001), but in either Congo or Chinese group, other complications (perinatal fetus the mortality and brachial plexus injury producing tumors, and GDM) are no correlation (P0.05). This study shows that only a Congo woman (1.1%) infection after childbirth, 11 Congo women (12.6%) complicated with postpartum hemorrhage, a Congo woman (1.1%) occurred Rupture of the uterus. In vaginal delivery women in Congo, there were 19 cases (21.9%) with perineal laceration, showed a clear correlation between perineal laceration and vaginal delivery (X2 =7.675 and P0.001). However, no Chinese women postpartum hemorrhage, infection or rupture of the uterus. The vaginal delivery of Chinese women only, 2 cases (25%) with perineal laceration, but perineal laceration and Congo compared with no statistical significance (P = 0.05). Conclusion GDM was significantly associated with fetal macrosomia, and can cause some complications, such as neonatal Apgar score low, hypoglycemia, head circumference and birth weight increase, which also induce some maternal complications for example, vaginal delivery of maternal perineal laceration. Race (Chinese or Congo) and the gender of the baby should be considered as the influence factors of macrosomia weight. Chinese macrosomia weight more than Congo big son, the boy in the two groups The weight of more than baby girls. For macrosomia tendency of pregnant women should give better management, according to the clinical and / or ultrasound guidance, so as to give advanced maternal labor induction and selective caesarean section. We should strengthen control of glucose ingestion during pregnancy to reduce the risk of neonatal hypoglycemia. We should strengthen the Department of Obstetrics and Gynecology the doctor, pediatrician and nutritionists work to minimize the adverse consequences of maternal and fetal.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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