本文選題：孕前糖尿病 + 圍產(chǎn)兒結(jié)局��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討孕前糖尿病孕婦的發(fā)生率變化趨勢及規(guī)范管理血糖后對圍產(chǎn)兒結(jié)局的影響。方法2012年1月1日至2016年12月31日在大連醫(yī)科大學(xué)附屬第一醫(yī)院產(chǎn)科分娩的孕前糖尿病患者共162例,根據(jù)孕期血糖控制情況,分為血糖控制良好組83例(A組)和血糖控制不良組79例(B組)。采用回顧性分析的方法對孕前糖尿病的圍產(chǎn)兒結(jié)局進行分析,并對孕前糖尿病患者的發(fā)生率進行統(tǒng)計。結(jié)果(1)孕前糖尿病患者在2012年1月1日—2016年12月31日5年的總發(fā)生率為2.25%,每年的發(fā)生率分別為1.48%、2.09%、1.45%、4.03%、3.12%,總體呈上升趨勢。(2)A、B兩組患者在年齡、孕周、孕次、產(chǎn)次、不良孕娩史、家族史差異無統(tǒng)計學(xué)意義(P0.05)。(3)A組圍產(chǎn)兒不良結(jié)局中的流產(chǎn)、巨大兒、低血糖、高膽紅素血癥、新生兒呼吸窘迫綜合征的發(fā)生率明顯小于B組(P0.05);胎兒畸形、死胎(死產(chǎn))、新生兒死亡、早產(chǎn)兒、FGR、胎兒窘迫、轉(zhuǎn)入NICU發(fā)生率兩組相比無顯著性差異(P0.05)。(4)兩組孕婦的分娩孕周無明顯差異(P0.05),A組的出生體重明顯小于 B 組(P0.05)。(5)A組孕前及孕早期干預(yù)比率高于B組,有統(tǒng)計學(xué)意義(P0.05);A組依靠飲食+運動治療的比率分別小于B組,加胰島素治療的比率高于B組(P0.05);A組中陰式分娩和剖宮產(chǎn)的比率與B組相比無明顯差別(P0.05)。結(jié)論(1)2012年-2016年每年的發(fā)生率呈上升趨勢,應(yīng)重視對孕前糖尿病的篩查、診斷和干預(yù)。(2)孕前糖尿病的血糖控制良好時可明顯改善圍產(chǎn)兒結(jié)局,降低流產(chǎn)、巨大兒、低血糖、高膽紅素血癥、RDS等發(fā)生率。(3)對孕前糖尿病患者的血糖干預(yù)時間提前可改善圍產(chǎn)兒結(jié)局。(4)孕前糖尿病病情相對較長、較重,規(guī)范管理血糖可明顯改善圍產(chǎn)兒結(jié)局。
[Abstract]:Objective to investigate the incidence trend of pregestational diabetes in pregnant women and the influence of blood glucose management on perinatal outcome. Methods from January 1, 2012 to December 31, 2016, 162 cases of pregestational diabetes were given birth in the first affiliated Hospital of Dalian Medical University. The patients were divided into two groups: group A (83 cases) and group B (79 cases) with poor blood glucose control. The perinatal outcome of pregestational diabetes mellitus and the incidence of pregestational diabetes mellitus were analyzed retrospectively. Results (1) the total incidence of pregestational diabetes in the 5 years from January 1, 2012 to December 31, 2016 was 2.25, and the annual incidence was 1.48, 2.09 and 1.45, respectively. There was an overall rising trend in the age, gestational week, pregnancy, labor, and history of poor pregnancy in the two groups. There was no significant difference in family history. The incidence of miscarriage, macrosomia, hypoglycemia, hyperbilirubinemia and neonatal respiratory distress syndrome in group A was significantly lower than that in group B (P 0.05). Stillbirth (stillbirth, neonatal death, premature FGR, fetal distress, There was no significant difference between the two groups in the incidence of transfer to NICU (P 0.05) there was no significant difference in the gestational weeks of delivery between the two groups. The birth weight of group A was significantly lower than that of group B (P 0.05). The rate of intervention before pregnancy and in early pregnancy in group A was significantly higher than that in group B. The ratio of diet and exercise therapy in group A was significantly lower than that in group B, and the rate of insulin therapy was higher than that in group B (P 0.05). There was no significant difference in the rates of midvaginal delivery and cesarean section between group A and group B. There was no significant difference between group B and group B in the proportion of midvaginal delivery and cesarean section. Conclusion (1) the annual incidence of pregestational diabetes is on the rise from 2012 to 2016. We should pay attention to the screening of pre-gestational diabetes, diagnosis and intervention. 2) when blood glucose control of pre-gestational diabetes is good, it can obviously improve perinatal outcome and reduce abortion, macrosomia and hypoglycemia. The incidence of hyperbilirubinemia / RDS et al.) the intervention time of blood glucose in patients with pre-gestational diabetes could improve perinatal outcome. (4) the condition of pre-gestational diabetes was relatively long and severe, and standardized blood glucose management could significantly improve the perinatal outcome.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256
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本文編號：1996054