陈海霞　谷晓芬

[摘要] 目的 研究妊娠期糖尿病（GDM）巨大儿的相关因素。 方法 选择2013年3月～2014年5月北京市昌平区中医医院收治的124例GDM患者，根据娩出胎儿是否为巨大儿将其分为巨大儿组（观察组，36例）和非巨大儿组（对照组，88例）。回顾性分析两组患者的一般情况、血糖水平、治疗开始孕龄、糖化血红蛋白、接受治疗情况、治疗方案和血糖控制的满意度。 结果 观察组患者的新生儿体重[（4389.2±369.6）g]显著高于对照组[（3367.1±386.3）g]，差异有高度统计学意义（t = 13.539，P < 0.01）；两组产次及巨大儿分娩史比较，差异均有统计学意义（χ2=7.525、4.969，均P < 0.05）。两组患者OGTT 2 h血糖的水平及治疗开始孕龄比较，差异无统计学意义（t = 0.475、0.357，均P > 0.05），但是观察组糖化血红蛋白水平[（6.78±0.87）%]明显高于对照组[（5.21±0.97）%]，差异有高度统计学意义（t = 8.421，P < 0.01）。观察组患者接受治疗率（55.56%）显著低于对照组（78.41%），差异有统计学意义（u = 6.587，P < 0.05）。观察组患者的治疗方案主要是饮食调节，对照组则是在饮食调节下进行胰岛素治疗，差异有高度统计学意义（χ2=7.264，P < 0.01）。对照组的血糖控制满意度（92.05%）显著高于观察组（72.22%），差异有高度统计学意义（u = 2.901，P < 0.01）。 结论 妊娠期糖尿病巨大儿的发生与多种因素相关，为此孕妇在产前应进行严格的产检，当确诊GDM后应当积极配合治疗，随时保持血糖处于理想水平的状态，有利于降低巨大儿的发生率。

[关键词] 妊娠；糖尿病；巨大儿；相关因素

[中图分类号] R714.256 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0100-04

[Abstract] Objective To study the related factors of great children in patients with gestational diabetes. Methods 124 cases of patients with GDM from March 2013 to May 2014 in Changping Hospital of Traditional Chinese Medicine were selected， and they were divided into great children group （observation group， 36 cases） and non-great children group （control group， 88 cases） according to whether delivered a great children. The general condition， blood sugar levels， gestation age of begin treatment， glycosylated hemoglobin， situation of treatment acceptation， treatment regimens and satisfaction of glycolic control of two groups were retrospectively analyzed. Results The weight of newborn in the observation group [（4389.2±369.6） g] was significant higher than that of the control group [（3367.1±386.3） g]， the difference was statistically significant （t = 13.539， P < 0.01）， production times and the history of great children between two groups had statistically significant differences （χ2=7.525， 4.969， all P < 0.05）. blood sugar levels at OGTT 2 h， gestation age of begin treatment of patients in two groups had no statistically significant difference （P > 0.05）， but glycosylated hemoglobin of the observation group [（6.78±0.87）%] was significantly higher than that of the control group [（5.21±0.97）%]， the difference was statistically significant （t = 8.421， P < 0.05）； rate of treatment acceptation of patients in the observation group （78.41%） was significantly higher than that of the control group （55.56%）， the difference was statistically significant （u = 6.5865， P < 0.05）； diet-regulated was the main therapy of the observation group， and insulin therapy assisted in regulation of diet was the main therapy of the control group， the difference was statistically significant （χ2=7.264， P < 0.01）； satisfaction of blood glucose control in the control group （92.05%） was significantly higher than that of the observation group （72.22%）， the difference was statistically significant （u = 2.9014， P < 0.01）. Conclusion Many factors are relate to great children in patients with gestational diabetes， so pregnant women should carry out strict prenatal check-ups and actively cooperate with treatment when diagnosed with CDM， and to keep blood sugar in the ideal levels， which will help to reduce the incidence of great children.

[Key words] Pregnancy； Diabetes； Great children； Related factors

近年来，随着社会经济水平的发展，人们生活质量不断提高，巨大儿的发生率也呈现出不断增长的趋势[1]。巨大儿的出现可能致使产伤、难产、新生儿窒息及产后出血等严重后果，甚至不利于新生儿的智力发展，并且神经系统也会遭受损害，严重者可能会致新生儿死亡[2]。相关研究表明，妊娠期糖尿病（gestational diabetes mellitus，GDM）导致巨大儿发生的概率为25%～45%，与正常孕妇比较，显然具有较高的发生率[3]。GDM不但增加了巨大儿发生的概率，也会增加母婴的并发症的发病率。为此，为降低巨大儿的发生率，本研究就妊娠期糖尿病巨大儿的相关因素进行分析。现报道如下：

1 资料与方法

1.1 一般资料

选择2013年3月～2014年5月北京市昌平区中医医院（以下简称“我院”）收治的124例GDM患者为研究对象。所有患者均为单胎，均未合并内外科疾病。根据是否为巨大儿分为观察组（36例）和对照组（88例），其中观察组的新生儿为巨大儿，体重超过4000 g，对照组的新生儿为非巨大儿，体重为2200～3999 g。……