目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)一日门诊课堂对GDM孕妇孕期糖脂代谢及分娩结局的干预效果.方法 于2019年7月—2020年12月在厦门市妇幼保健院手术室及产房收集经糖耐量试验(oral glucose tolerance test,OGTT)后,被诊断为GDM的孕妇 347 例.将这些孕妇分为两组,一组为营养门诊宣教组,共有215例,将其列为GDM A组;一组为GDM一日门诊宣教组,共有132例,将其列为GDM B组.两组孕妇在控制血糖期间,均由营养医师开具个体化的GDM食谱,并均有定期监测血糖.另外,选择同期在厦门市妇幼保健院定期产检并分娩的糖耐量试验正常的孕妇234名,作为正常组.回顾性收集三组孕妇孕期血脂、血糖、分娩结局等临床数据,分析三组孕妇在上述指标上的差异.由此,评价GDM一日门诊课堂对GDM孕妇孕期糖脂代谢及分娩结局的干预效果.结果 (1)GDM A组和GDM B组孕妇的身体质量指数(body mass index,BMI)分别为(21.61±3.24)kg/m2 和(21.58±2.54)kg/m2,高于正常组孕妇的(20.23±2.25)kg/m2(P＜0.05).(2)三组孕妇孕晚期血脂各项指标(胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白)水平均高于孕早期.孕早期,GDM A组和GDM B组的低密度脂蛋白水平高于正常组孕妇,而高密度脂蛋白水平则低于正常组孕妇.孕晚期,GDM A组和GDM B组的高密度脂蛋白水平低于正常组孕妇,均差异有统计学意义(P＜0.05).(3)GDM B组孕妇孕晚期糖化血红蛋白水平为(5.21±0.41)%,低于GDM A组的(5.41±0.46)%;而胰岛素的使用率为11.36%,也低于GDM A组的20.93%,差异有统计学意义(P＜0.05).(4)GDM B组的巨大儿发生率为6.06%(8/132),低于GDM A组的15.35%(33/215)和正常组的 13.67%(32/234).同时,GDM B组的剖宫产率为15.91%(21/132),同样低于GDM A组的25.12%(54/215)和正常组的26.92%(63/234),差异有统计学意义(P＜0.05).结论 营养门诊一对一的饮食宣教模式和GDM一日门诊课堂的集中宣教模式均能改善GDM孕妇妊娠结局,改善血脂代谢情况.但相对于传统的营养门诊,GDM一日门诊课堂的健康教育引导模式更能维持GDM孕妇的血糖平稳状态,也能降低孕期的胰岛素使用率、巨大儿发生率和剖宫产率.

目的:探讨多囊卵巢综合征(PCOS)不孕患者不同血清抗苗勒管激素(AMH)水平与卵巢反应及体外受精-胚胎移植(IVF-ET)助孕结局的关系,阐明血清AMH水平对PCOS患者助孕结局的影响,为PCOS患者助孕治疗方案的选择提供依据.方法:选取行IVF-ET助孕21～39岁患者1837例,根据是否被诊断为PCOS分为PCOS组(n=910)和非PCOS组(n=927);PCOS组中有437例患者进行新鲜单优质囊胚移植,根据其血清AMH水平分为AMH<7μg·L-1组和AMH≥7μg·L-1组,并根据患者年龄分为20～24岁组、25～29岁组、30～34岁和35～39岁组.比较PCOS组与非PCOS组患者年龄、血清AMH水平、促性腺激素(Gn)用量、人绒毛膜促性腺激素(HCG)日雌二醇(E2)值、获卵数、预防卵巢过度刺激综合征(OHSS)取消移植率和临床妊娠率;分析PCOS组不同血清AMH水平患者Gn用量、HCG日E2值、获卵数、预防OHSS取消移植率和临床妊娠率;比较PCOS组中不同年龄段妊娠组与非妊娠组患者血清AMH水平.结果:PCOS组患者血清AMH水平、HCG日E2值、获卵数和预防OHSS取消移植率均高于非PCOS组(P<0.05),Gn用量和临床妊娠率则低于非PCOS组(P<0.05).PCOS组患者血清AMH水平与HCG日E2值和获卵数呈正相关关系(r=0.502,P=0.001;r=0.233,P=0.001),与Gn用量呈负相关关系(r=-0.400,P=0.001).PCOS组中AMH≥7μg·L-1组患者HCG日E2值、获卵数和预防OHSS取消移植率较AMH<7μg·L-1组增加(Z=-3.952,P=0.001;Z=-2.858,P=0.004;χ2=23.154,P=0.001);Gn用量和临床妊娠率较AMH<7μg·L-1组降低(Z=-6.727,P=0.001;χ2=6.640,P=0.010).PCOS组中妊娠组患者血清AMH水平低于非妊娠组(Z=-4.192,P=0.001);在25～29岁组和30～34岁组中妊娠组患者血清AMH水平低于非妊娠组(Z=-2.197,P=0.028;Z=-3.700,P<0.01).结论:对血清AMH≥7μg·L-1 PCOS患者应预处理以降低AMH后再行助孕,在IVF-ET助孕中应掌握好Gn用量,以降低HCG日E2值,降低预防OHSS取消移植率,争取有鲜胚移植机会并提高临床妊娠率,改善助孕结局.

目的 探讨产前全程护理对妊娠期糖尿病患者血糖水平及母婴结局的影响.方法 便利选取该院2019年12月—2020年8月收治的102例妊娠期糖尿病患者,采取随机分组法分为对照组和观察组,各51例,对照组采取常规护理,观察组采取产前全程护理,对比两组血糖控制及母婴结局.结果 护理后,观察组空腹血糖(4.32±0.88)mmol/L、餐后2 h血糖水平(6.45±1.08)mmol/L低于对照组(5.33±1.14)mmol/L、(8.76±1.70)mmol/L,差异有统计学意义(t=5.008、8.191,P<0.001);观察组胎内窘迫率、新生儿窒息率、母婴喂养成功率优于对照组,差异有统计学意义(χ2=4.387、4.387、13.949,P<0.05);护理后,对照组焦虑评分(50.42±2.09)分与观察组(43.51±2.47)分比较,差异有统计学意义(t=15.251,P<0.001),对照组抑郁评分(49.21±1.63)分与观察组(39.37±1.06)分比较,差异有统计学意义(t=36.141,P<0.001);观察组生理、心理、精神、社会关系评分高于对照组,差异有统计学意义(t=6.414、6.529、13.014、6.828,P<0.001).结论 针对妊娠期糖尿病患者,实施产前全程护理,可有效控制患者血糖水平,提高母婴安全性,临床价值高,值得推广.

目的 探讨分析运动护理对妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血糖控制效果及分娩结局的影响,并为后续的临床治疗与护理提供参考依据.方法 2018年3月—2021年3月方便选取厦门大学附属妇女儿童医院诊治的800例GDM孕妇为研究对象,以随机数表法将其分为研究组与对照组,各400例.对照组进行常规护理,研究组在此基础上进行运动护理.分析两组患者血糖控制情况及糖化血红蛋白水平、不良妊娠结局发生率、心理状态评分.结果 两组患者干预前的FPG、2 hPG、HbA1c水平差异无统计学意义(P>0.05);干预后两组患者FPG、2 hPG、HbA1c水平均显著下降,与对照组相比,研究组的上述指标下降更明显,差异有统计学意义(P<0.05).研究组患者不良妊娠结局发生率为5.25％,低于对照组的9.50％,差异有统计学意义(P<0.05).干预前,两组的SAS、SDS评分差异无统计学意义(P>0.05);干预后,两组的SAS、SDS评分均降低,且研究组的SAS、SDS评分下降幅度高于对照组,差异有统计学意义(P<0.05).结论 运动护理模式应用于GDM患者不仅可以有效控制患者血糖指标,降低不良妊娠结局发生率,也可以有效提升患者的心理状态与护理满意度,具有良好的临床推广价值.

Objective To explore the effect of the intervention of the flipped class on the glucose and lipid metabolism,the body weight gain and the delivery outcomes of the pregnant women with the gestational diabetes mellitus (GDM).Methods From January 2021 to January 2022,we collected 285 pregnant women who were diagnosed as the GDM in the nutritional clinic and the flipped class of Xiamen maternal and child health hospital.Among them,172 cases received the dietary guidance in the nutrition clinic,they were classified as GDM group A.Meanwhile,114 cases received centralized education in the flipped class,they were classified as GDM group B.In addition,193 pregnant women with the normal glucose tolerance test were selected as the control group.We collected and analyzed the biochemical indexes such as the blood lipid,the blood glucose,the body weight gain during pregnancy and the delivery outcomes of the three groups of the pregnant women by statistical methods.By this way,we wanted to evaluate the intervention effect of the GDM flipped class on the glucose and lipid metabolism,the body weight gain and the delivery outcomes of the pregnant women with GDM.Results The pre pregnancy body mass index (BMI) of GDM group A and GDM group B were (21.6±3.0) kg/㎡ and (21.1±2.3) kg/㎡,respectively,which were higher than that of the normal group (20.2±2.1) kg/㎡,(P＜0.05).From 13th to 24th week of the pregnancy,the body weight gain of pregnant women in GDM group A and GDM group B was (4.89±2.50) kg and (4.88±2.02) kg,respectively,which were higher than that of the pregnant women in normal group (4.26±1.50) kg,and the difference was statistically significant(P＜0.05).From 24th to 36th week of pregnancy,the body weight gain of pregnant women in GDM group A and GDM group B was (5.47±2.91) kg and (5.28±2.53) kg,respectively,which were lower than that of pregnant women in the normal group (6.23±2.32) kg.The difference was also statistically significant (P＜0.05).In the early stage of pregnancy,the levels of low-density lipoprotein (LDL) in GDM group A and GDM group B were (2.22± 0.65) mmol/L and (2.28±0.72) mmol/L,respectively,which were higher than that of the normal group (2.03±0.62) mmol/L,and the levels of high-density lipoprotein (HDL) were (1.61±0.30) mmol/L and (1.63±0.32) mmol/L,respectively,which were lower than that of the normal group (1.76±0.34) mmol/L,with statistical significance (P＜0.05).In the third trimester,the levels of HDL in GDM group A and GDM group B were (1.86±0.38) mmol/L and (1.85±0.38) mmol/L,respectively,which were lower than that of the normal group (1.98±0.43) mmol/L,with statistical significance (P＜0.05).The glycosylated hemoglobin level of pregnant women in GDM group A was (5.37±0.37)% higher than that of GDM group B (5.19±0.34)% ,and the insulin use rate of pregnant women in GDM group A was 21.51% (37/172),also higher than that of GDM group B 10.53% (12/114).The differences were statistically significant (P＜0.05).The incidence of macrosomia in GDM group B was 6.14% (7/14),lower than that in GDM group A 14.53% (25/172) and control group 15.54% (30/193).The cesarean section rate of GDM group B was 15.79% (18/114),which was also lower than that of GDM group A 23.84% (41/172) and normal group 30.05% (58/193),the differences were statistically significant (P＜0.05).Conclusion Timely and reasonable nutrition intervention can improve the pregnancy outcomes of GDM pregnant women,can control the body weight gain of GDM pregnant women in the second and third trimester,and can improve the blood lipid metabolism.Compared with the one-to-one education mode in the nutrition clinic,the GDM ?ipped class mode can better improve the blood glucose metabolism of GDM pregnant women with lower insulin use rate,lower incidence of macrosomia and lower cesarean section rate.

目的 在分析探讨妊娠期糖尿病(GDM)危险因素的基础上构建GDM发病风险预测模型并评价该模型的预测效能.方法 采用队列研究方法,收集符合纳入标准、信息资料完整的孕妇479例.采用随机数字方法,将队列人群分为两个子集,即观察集(310例)和验证集(169例).观察集用于探讨与GDM发病相关的危险因素并构建预测模型;验证集用于评估该模型的预测效能.结果 在观察集中,以74例GDM孕妇为GDM组,以236例糖耐量正常孕妇为对照组,经单因素分析显示:GDM组中有GDM史、孕妇母亲有糖尿病史的比例高于对照组;GDM组孕妇的年龄、孕早期空腹血糖、尿酸、低密度脂蛋白水平均高于对照组孕妇.经多因素Logistic回归分析显示,本研究中建立的GDM发病风险预测模型公式为:Y=Logistic(P)=-1.975+2.201×X1+0.888×X2+0.781×X3+0.686×X4+0.893×X5,其中 X1:有无 GDM 史;X2:年龄是否超过 35 岁;X3:孕前体质指数(BMI)是否超过24.0 kg/m2;X4:孕早期空腹血糖是否超过5.15 mmol/L;X5:孕早期低密度脂蛋白是否超过2.5 mmol/L.将上述方程导入验证集数据,经受试者工作特征曲线(ROC)分析,结果显示:该曲线下面积为0.836,P＜0.05,当阈值Y=-0.301时,该模型的效能较好.此时,该模型的阳性预测值为66.67％、阴性预测值为84.61％、灵敏度为46.15％、特异度为93.07％、约登指数为0.469 2.结论 本研究构建的GDM发病风险预测模型具有一定的临床应用价值.在今后的研究中,可以考虑将有无GDM史、年龄是否超过35岁、孕前BMI是否超过24.0kg/m2、孕早期空腹血糖是否超过5.15 mmol/L及孕早期低密度脂蛋白是否超过2.5 mmol/L作为构建GDM发病风险预测模型的变量.

目的 探讨营养干预对妊娠期糖尿病（GDM）孕妇孕期体重增长、血脂水平及分娩结局的影响。方法 选择2020年1月至2021年8月在厦门市妇幼保健院产科门诊及营养门诊就诊的GDM孕妇135例（GDM组）及同期就诊的糖耐量试验正常孕妇463例（正常组）。对GDM孕妇予以一对一的营养指导，开具妊娠期糖尿病食谱并嘱其监测血糖；对糖耐量试验正常的孕妇则依据孕期膳食指南予以饮食指导。收集两组孕妇基本信息资料、孕期体重增长情况、孕中晚期血脂水平及分娩结局，探讨分析营养干预对GDM孕妇孕期体重增长、血脂水平变化及分娩结局的影响。结果 （1）两组孕妇年龄、文化程度差异无统计学意义；GDM组孕妇孕前BMI高于正常组孕妇，但两组在孕前BMI分层方面差异无统计学意义。（2）孕24周前，GDM组孕妇体重增长幅度超过正常组孕妇（P＜0.05）；孕24～36周期间，GDM孕妇体重增长幅度小于正常组孕妇（P＜0.05）。整个孕期阶段，两组孕妇孕期体重总增长幅度差异无统计学意义（P＞0.05）。（3）在孕中期，GDM组孕妇甘油三酯水平高于正常组孕妇，而高密度脂蛋白水平低于正常组孕妇（P＜0.05）；在孕晚期，两组孕妇甘油三酯及高密度脂蛋白水平差异无统计学意义（P＞0.05），但GDM组孕妇的低密度脂蛋白水平低于正常组孕妇（P＜0.05）。同时，从整个孕期来看，两组孕妇在血脂各项指标方面均呈上升趋势。（4）两组孕妇在新生儿出生体重、分娩孕周、巨大儿发生率、早产率、剖宫产率、新生儿低血糖发生率等方面，差异均无统计学意义（P＞0.05）。结论 对GDM孕妇给予及时、合理的饮食控制，能有效地改善GDM孕妇的分娩结局。饮食控制期间，GDM孕妇的体重增长幅度会有所减小，甚至可能出现短期内的体重下降，但这并不影响胎儿的生长。同时，饮食控制也能改善GDM孕妇的血脂水平，主要体现在减小低密度脂蛋白上升幅度方面。

目的:探讨再生育时并发妊娠期糖尿病(GDM)的孕妇产后发生糖代谢紊乱的相关危险因素.方法:采用队列研究方法,选择信息资料完整的再生育GDM孕妇270例,追踪其妊娠结局且在产后6～12周复查75 g葡萄糖耐量试验(OGTT),以OGTT结果为分组依据分为产后糖代谢正常组及产后糖代谢异常组.采用单因素及多因素Logistic回归分析再生育GDM孕妇产后发生糖代谢紊乱的相关危险因素.结果:o例患者中产后糖代谢正常197例;产后糖代谢异常73例,其中糖耐量受损62例,糖尿病11例,糖代谢紊乱的发生率为27.04％.②单因素分析结果显示:产后糖代谢异常组GDM病史≥2次的比例、产后血糖不稳定率、孕晚期甘油三酯(TG)、OGTT 0小时、OGTT 1小时、OGTT 2小时血糖的均值均高于产后糖代谢正常组,差异均有统计学意义(P＜0.05).③Logistic回归分析显示:GDM病史≥2次、产后血糖不稳定、孕晚期TG≥3.6mmol/L、OGTT 0小时血糖≥5.24 mmol/L、OGTT 1小时血糖≥10.77 mmol/L、OGTT 2小时血糖＞9.38 mmol/L均是再生育GDM孕妇产后发生糖代谢紊乱的独立危险因素(OR＞1,P＜0.05),其中GDM病史≥2次发生糖代谢的风险最大(OR4.531,95％ CI 1.907 ～ 10.766).结论:对再生育的GDM孕妇临床上应高度重视其产后6 ～ 12周发生糖代谢紊乱的可能,尤其是既往GDM病史超过2次的孕妇,同时,孕期应注意控制TG及血糖水平,哺乳期间应加强维持血糖的稳定性.

OBJECTIVESGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It is associated with a wide range of short and long term adverse health consequences for both mother and offspring. As we know, the risk factors of the GDM are complex and diverse, and the incidence of GDM is directly correlated with the age and the times of women delivery. In the process of exploring the risk factors of GDM, if the 2 known independent risk factors are unevenly distributed among groups, the effects of other risk factors may be concealed. To avoid the influence of the 2 factors on the research results, we collected primiparous women as the participants through the method of the case-control study of age 1꞉1 paired design. Through this way, we want to provide early intervention for the pregnant women with the high risk factors so as to reduce the possibility of the GDM during the pregnancy and promote the maternal and infant's health.METHODSThis study was a retrospective study. A total of 2 425 pregnant women were collected as the participants, who accepted the regular prenatal examination or nutrition health guidance in the Department of Obstetrics or Nutrition in the Women and Children's Hospital, School of Medicine, Xiamen University from August 2018 to October 2019. According to the inclusion and exclusion criteria, 2 287 pregnant women were included in the study. Among them, 231 pregnant women with the complete information were collected as a case group because of the abnormal results of the oral glucose tolerance test (OGTT) that executed between the 24th and 28th weeks during the pregnancy. Meanwhile, among the participants with the normal results of the OGTT, 231 pregnant women with the complete information were selected randomly as a control group through the method of the age 1꞉1 paired with the case group. The age range of the all subjects was 22 to 45 (28.82±4.03) years old. We collected their clinical and basic data retrospectively, including the BMI before pregnancy, the level of uric acid, fasting blood glucose, serum lipid index, and glycosylated hemoglobin (HbA1c) in the early pregnancy, the body weight gain before the 13th and 24th weeks during the pregnancy, the times of the abortions, the positive of HBsAg, the family history of diabetes or hypertension etc. The differences in these indexes were compared between the 2 groups. The logistic regression analysis was used to explore the risk factors for GDM and the stratified analysis was used to explore the difference of the body weight gain before the 24th week during the pregnancy between the 2 groups.RESULTSThe BMI before pregnancy, the uric acid, the fasting blood glucose, the body weight gain before the 13th and 24th weeks during the pregnancy in the GDM group were higher than those in the control group, and the differences were significant (all P<0.05). The LDL level in the early pregnancy of the GDM group was higher than that of the control group, however, the HDL level in the early pregnancy of the GDM group was lower than that of the control group, and the differences were significant (both P<0.05). The rates of the pregnant women in the GDM group with more than 2 abortions, obesity or overweight before pregnancy, the fasting blood glucose in the early pregnancy over 5.1 mmol/L were significantly higher than those in the control group (all P<0.05). With the uptrend of the cut-off point of the body weight gain before the 24th week during the pregnancy, the risk of the GDM was gradually increasing. When the cut-off point reached at 10 kg, the difference was significant (OR=1.988, P=0.004). The level of HDL in the early pregnancy over 1.6 mmol/L was the protective factor for GDM (OR=0.460, P=0.016). Meanwhile, the body weight gain over 10 kg before the 24th week during the pregnancy (OR=1.743, P=0.032), the fasting blood glucose in the early pregnancy over 5.1 mmol/L (OR=3.488, P=0.001), the LDL in the early pregnancy over 2.5 mmol/L (OR=2.179, P=0.032) were the risk factors for the GDM. Among them, the fasting blood glucose in the early pregnancy over 5.1 mmol/L had the greatest impact on the increase of risk for the GDM.CONCLUSIONSAfter excluding the influence of the age, for primiparous women, the higher level of the LDL and the fasting blood glucose in the early pregnancy, the higher possibility to be the GDM. Meanwhile, the pregnant women should control their diet as soon as possible to control the body weight gain within 10 kg before the 24th week during the pregnancy so as to reduce the possibility of being GDM.

目的 探讨孕期血脂各项指标的变化趋势并分析与妊娠期糖尿病(gestational diabetes mellitus,GDM)相关的危险因素.方法 采用巢式病例对照研究方法,先从研究队列人群中选择382例病历资料完整的GDM患者作为病例组,经饮食控制后,该病例组中有56例GDM孕妇需加用胰岛素治疗(A1组),326例无需胰岛素治疗(A2组).以GDM组孕妇的年龄段分布为匹配因素1:1配对,从糖耐量试验正常的孕妇中选择382例孕妇作为对照组.收集其基本信息、不同孕期阶段血脂水平及其他有关临床数据,采用卡方检验、两样本均数比较的t检验、重复测量方差分析、Logistic回归分析等方法进行数据分析.结果 ①随着孕期的增加,两组孕妇血脂各项指标均有上升的趋势;在孕早期和孕中期,GDM组低密度脂蛋白平均水平高于对照组(P＜0.05),到了孕晚期两组水平较为接近;而整个孕期GDM组的高密度脂蛋白水平均低于正常组孕妇,差异有统计学意义(P＜0.05).②Logistic回归分析显示,孕早期高密度脂蛋白≥1.6 mmol/L是GDM的保护因素(OR =0.533,95％ CI:0.334 ～0.849,P=0.008),而孕24周前体重总增长超过10 kg(OR=1.575,95％ CI:1.060～2.340,P=0.024)、孕早期空腹血糖超过5.1 mmol/L(OR =2.380,95％CI:1.657 ～3.419,P=0.001)、有妊娠期糖尿病史(OR=2.949,95％CI:1.179 ～7.373,P=0.021)、孕早期低密度脂蛋白≥2.5 mmol/L(OR=2.544,95％CI:1.470～4.401,P=0.001)则是GDM的危险因素.其中,有妊娠期糖尿病史的影响程度最大.结论 ①随着孕周的延长,孕妇体内血脂各项指标均有上升趋势,较高水平的高密度脂蛋白可能是GDM的保护因素.②对有妊娠期糖尿病史、孕早期低密度脂蛋白超过2.5 mmol/L、孕早期空腹血糖超过5.1 mmol/L的孕妇应当加强监管,并建议孕妇在24周前将体重增长幅度控制在10 kg以内,以降低其在孕中、后期发生妊娠期糖尿病的可能性.

目的 探讨巨大儿发生的影响因素,为制定预防分娩巨大儿的措施提供参考依据.方法 选取2017年1-12月在厦门市妇幼保健院分娩巨大儿且有完整孕期信息资料的孕妇270例为巨大儿组.以上述孕妇的年龄为匹配因素,另收集同期在该院分娩胎儿出生体质量在2 500～3 999g之间、孕期信息资料完整的270例孕妇为正常组.分析两组孕妇孕前BMI、流产次数、不同孕期体质量增长及血脂水平等的差异.结果 多因素分析结果显示,妊娠期糖尿病(OR=2.698),孕前BMI≥24.0 kg/m2(OR=2.680),孕晚期低密度脂蛋白≥3.0 mmol/L(OR=2.799),孕晚期三酰甘油≥2.8 mmol/L(OR=4.868)、孕13～28周体质量增长≥9.0 kg(OR=2.407)、孕期总体质量增长≥16.0 kg(OR=4.079)均是分娩巨大儿的危险因素(P＜0.05).其中孕晚期三酰甘油≥2.8 mmol/L对巨大儿的发生影响最大.结论 合理控制孕期体质量增长,使得孕中期体质量总增长＜9 kg,整个孕期体质量增长＜16 kg是预防巨大儿发生的重要措施.产科医生应该关注孕期血脂水平,孕晚期三酰甘油≥2.8 mmol/L、低密度脂蛋白≥3.0 mmol/L对巨大儿的发生可能有促进作用.妊娠期糖尿病是分娩巨大儿的高危因素,临床应给予规范的饮食控制以降低巨大儿的发生率.

OBJECTIVE:To study the incidences of group B streptococcus (GBS) colonization in pregnant women and GBS infection in their preterm infants, and to investigate the risk factors for GBS colonization in preterm infants. METHODS:A total of 859 women who delivered before term from January 2017 to January 2018 were enrolled in this prospective cohort study. Bacterial culture was performed for GBS using the swabs collected from the rectum and the lower 1/3 of the vagina of the pregnant women on admission. A total of 515 of the above cases underwent real-time PCR assay for testing of GBS DNA. Bacterial culture was performed for GBS using the oropharyngeal secretion, gastric fluid or blood samples in preterm infants born to the 859 pregnant women. Peripheral blood samples from the pregnant women and umbilical cord blood samples from their preterm infants were collected to determine the level of anti-GBS capsular polysaccharide antibody. The incidence of GBS infection and perinatal risk factors for GBS colonization in the preterm infants were examined. RESULTS:The positive rate for GBS in the rectal and vaginal cultures was 14.8% (127/859) among the 859 pregnant women, and the positive rate in the GBS DNA testing was 15.1% (78/515). There were 976 live-birth preterm infants delivered by 859 pregnant women, and 4.4% (43/976) of whom were GBS positive. Four preterm infants had early-onset GBS diseases, including pneumonia in two cases and sepsis in two cases. In 127 preterm infants delivered by 127 GBS-positive pregnant women, the preterm infant group with a gestational age between 34 and 37 weeks had a significantly lower GBS positive rate and a significantly higher level of anti-GBS capsular polysaccharide antibody compared with the preterm infant group with a gestational age of less than 34 weeks (P=0.013 and 0.001 respectively). A multivariate logistic regression analysis revealed that premature rupture of membranes time >18 hours and chorioamnionitis were independent risk factors for GBS colonization in preterm infants (OR=6.556 and 6.160 respectively; P<0.05). CONCLUSIONS:GBS positive rate and anti-GBS capsular polysaccharide antibody level in preterm infants are correlated with gestational age. premature rupture of membranes time >18 hours and chorioamnionitis may increase the risk of GBS colonization in preterm infants.

目的 分析孕妇在不同孕期的增重状况对巨大儿发生的影响,探讨降低新生儿巨大儿发生率的临床干预措施. 方法 回顾性分析2018年1～3月在我院分娩的328对新生儿及其母亲的临床资料.其中32对为巨大儿及其母亲,设为研究组;296对为体重正常的新生儿及其母亲,设为对照组.着重研究巨大儿与孕妇妊娠期增重状况的关联性,并分析相关混杂因素的影响,包括孕妇身高、年龄、产次、流产史、学历及新生儿性别等. 结果 两组间孕妇矮身材占比、高龄占比、初产率、流产史占比、学历程度、胎儿性别组成比,差异无统计学意义(P＞0.05);与对照组比较,研究组总孕期增重超标率升高(78.1% vs 37.5%),差异有统计学意义(P＜0.05);与对照组比较,研究组孕中期增重超标率升高(87.5% vs 51.4%),差异有统计学意义(P＜0.05). 结论 加强孕期体重管理、及时开展相关风险因素的识别与预警,是降低新生儿巨大儿发生率的有效手段.

目的:探讨孕期体质量增长及血脂各项指标的变化对妊娠期糖尿病(GDM)发病的影响.方法:以273例GDM患者为病例组,并以年龄段为匹配因素进行1:1的频数配对,以273例糖耐量试验正常的孕妇作为对照组.收集两组孕妇年龄、孕前体质量、身高、每次产检的孕周及体质量,检测孕早期(孕13周前)空腹血糖、糖耐量结果及孕早期(孕13周前)、孕中期(孕19 ～ 20周)、孕晚期(孕36 ～ 37周)的血脂水平等资料,分析GDM的影响因素.结果:多因素Logistic回归分析显示,孕前BMI≥24.0 kg/m2(OR=2.015,P=0.040)、孕早期空腹血糖≥5.10 mmol/L(OR=2.183,P=0.014)、孕中期低密度脂蛋白≥2.80 mmol/L(OR=3.484,P=0.001)及平均每周体质量增长≥0.80 kg(OR=2.789,P=0.004)均是GDM发病的独立危险因素,而孕中期高密度脂蛋白≥1.90 mmol/L(OR =2.015,P=O.04)则是GDM发病的保护因素.结论:临床上,产科医生应及早关注孕前BMI≥24.0 kg/m2、孕早期空腹血糖≥5.10 mmol/L、孕中期平均每周体质量增长≥0.80 kg及低密度脂蛋白≥2.80 mmol/L的孕妇.以上指标作为GDM独立危险因素的评估,可能对GDM的发生风险能进行更好的预测.

Patients with gestational diabetes mellitus (GDM) need strict blood glucose control to reduce the incidence of perinatal complications in the mother or infant. The purpose of this study was to investigate whether the glycated hemoglobin (HbA1c) values of GDM patients were affected by β-thalassemia minor and to subsequently discuss the limitations of HbA1c monitoring for blood glucose control.

OBJECTIVE:To discuss the risk factors of the gestational diabetes mellitus( GDM) among the re-birth pregnant women. METHODS:A total of 393 pregnant women with GDM were collected randomly according to the number of the antenatal care manual in the Maternal and Child Health Hospital in Xiamen City. Meanwhile, 393 pregnant women with normal glucose tolerance were chosen to be the control group matching withage of the GDM group. Their basic data would be analyzed, including the BMI before pregnancy, the degree of the education, the times of the abortion, the body weight gain during the pregnancy, their parental diabetes history, the birth weight of the last fetal, the history of GDM and so on. The two groups of people were re-birth pregnant women. RESULTS:Single factor analysis showed that among the GDM group, the total body weight gain before the 24 th week( 9. 11 ± 3. 09) kg and the proportion of their mothers with the DM( 64/393) were both higher than the control group( 7. 54 ± 2. 95) kg and( 38/393), however, the degree of the education was lower than the control group. Paired chi-square analysis showed that the history of macrosomia delivery( χ~2= 14. 297, P = 0. 001), the history of GDM( χ~2= 12. 938, P = 0. 001), and abortion history more than 2 times( χ~2=7. 078, P = 0. 010) were the risk factors of GDM for those women. Meanwhile, with the increasing of the fetal birth weight, the risk of being the GDM during the second pregnancy was also increasing. When the fetal birth weight reached 3. 8 kg, OR = 3. 467, the risk value reached a strong correlation. Multiple factors Logistic regression analysis showed those factors of GDM also had statistically significant differences, especially the bodyweight gain before the 24 th week over 10 kg played the most important role during the pregnancy( OR = 1. 875, P = 0. 001). CONCLUSION:The risk factors of the GDM for the re-birth pregnant women concluded the history of GDM, the history of macrosomia, the times of the abortion over twice, the bodyweight gain before the 24 th week over 10 kg, the low degree of the education, the pregnant women 's mother had the DM. For those pregnant women with fetal birth weight above 3. 8 kg, they should be included in the high risk population of GDM during the next pregnancy.

目的:探讨巨大儿发生的危险因素,以便及早采取有效措施以降低巨大儿发生率,并探讨采用干预措施对剖宫产分娩巨大儿的必要性.方法:选取2015年3月-2016年2月期间本院产科门诊定期产检并于手术室行剖宫产的孕妇394例,回顾性的收集其既往资料.根据胎儿出生体重将孕妇分为巨大儿组92例及正常组302例,分析巨大儿发生的相关因素.结果:孕前体型越重,孕期体重总增长越多,会增加巨大儿发生的风险.同时,孕36周胎儿的双顶径及腹围越大,发生巨大儿的风险也越高,当双顶径达到9.4 cm时,该风险值为2.284,当腹围达到34.0 cm时,该风险值为4.338.结论:应当将整个孕期体重控制在18 kg以内,尤其是针对孕前体型超重的孕妇,更应当控制其体重的增长.规范的饮食指导,能降低妊娠期糖尿病孕妇巨大儿的发生率.当36周胎儿的双顶径、腹围分别超过9.4 cm及34.0 cm时,应当及早控制饮食,以减少巨大儿发生的风险.巨大儿行剖宫产术的孕妇得到规范的护理干预后,可以有效减少各种并发症及不良反应的发生.

Objective To discuss about the method and the effect of the grouping-management on the special nurses in the operating room of the special hospital. Methods We executed the grouping-management on the special nurses in our operating room during the period of the study. Through this way, we wanted to analyze the differences between the fore-and-aft grouping-management in some aspects including the prepare of the instruments for operating, the instruments transmission, the mastery of the doctors’ habits, the degree of the cooperation between the doctors and the nurses, the mastery of the knowledge and the skills of the nurses, and so on. Results After executing the grouping-management, for those nurses, the degree of the proifciency of the instruments transmission, the mastery of the doctors’ habits, the cooperation between nurses and doctors, the mastery of the knowledge and skills were better than before this grouping-management (P<0.05).Conclusion There existed the obvious effect in the clinical practice after executing the grouping-management in the operating room in the special hospital. Through this way, we could improve the levels of the proifciency of the instruments transmitting and preparing, the mastery of the doctors’ habits, the cooperation between the doctors and nurses, what’s more, we could also enhance the mastery of the knowledge and the skills for the nurses. In a word, this management should be promoted to be used in the clinical practice.

目的：探讨健康教育对妊娠期糖尿病孕妇妊娠结局的影响。方法：选取2012年10月至2013年12月来我院进行治疗的妊娠期糖尿病患者44例，按照是否进行健康教育分为观察组和对照组，每组患者22例，比较两组患者妊娠的结局情况。结果：观察组患者新生儿低血糖情况、新生儿窒息情况、早产发生几率、剖宫产发生几率明显低于对照组患者，P＜0.05，具有显著性差异和统计学意义。结论：对妊娠期糖尿病患者进行健康教育，能够降低产妇并发症发生的几率，保证新生儿的生命安全，具有极强的临床推广应用价值。

目的:探讨分娩巨大儿的危险因素,为降低巨大儿发生率的干预措施提供参考依据,同时评价营养治疗对改善妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇妊娠结局的效果.方法:于2013～2014年期间,追踪随访在厦门市妇幼保健院常规产检并足月分娩的孕妇1 041例.收集研究对象的病历档案资料.妊娠期糖尿病的孕妇,一旦确诊后,即给予饮食指导,必要时使用胰岛素治疗.根据分娩结局将研究对象分为巨大儿组与非巨大儿组,探讨发生巨大儿的危险因素.同时,评价营养治疗对改善GDM孕妇妊娠结局的效果.结果:①随着年龄的增长,孕前BMI指数的增加,胎儿的出生体重有上升的趋势;同时,胎儿出生体长与出生体重呈正相关关系,相关系数为0.717.②多因素Logistic回归分析显示,孕前BMI指数越大(OR1=2.345,P1=0.046;OR2=4.597,P2 =0.005)、孕妇身高越高(OR1=2.086,P1=0.016;OR2 =9.934,P2 =0.001)、孕期体重总增长超过18 kg(OR=2.941,P=0.001)、胎儿性别为男性(OR=1.945,P=0.022)均是分娩巨大儿的危险因素(P＜0.05).③GDM孕妇,饮食控制血糖的达标率为79.8％.卡方分层分析显示,饮食控制未达标组的剖宫产率高于糖耐量试验正常组,差异有统计学意义(x2=6.682,P＜0.0125).在出生体重异常率方面,3组间(即GDM饮食控制达标组、饮食控制未达标组及糖耐量试验正常组)差异无统计学意义(P＞0.0125).结论:①巨大儿的发生与孕前体型超重、孕妇身材高大(尤其是身高超过170 cm)、孕期体重总增长超过18 kg、胎儿性别为男性有关.由于孕妇身高、胎儿出生时身长、胎儿出生体重三者间呈正相关关系,胎儿出生身长与胎儿出生体重的相关性为0.717,因此在判定是否为巨大儿方面,应当要考虑胎儿出生身长的因素.②饮食控制是GDM孕妇的关键治疗措施,饮食控制血糖的达标率可近80％,治疗后的GDM孕妇,胎儿出生体重异常率(巨大儿或小样儿)接近糖耐量试验正常的孕妇.