妊娠期糖尿病对母婴健康的影响和护理

论文编号:HL194  论文字数:10922.页数:26

论文题目：妊娠期糖尿病对母婴健康的影响和护理
摘　要
 背景  妊娠糖尿病(GDM)是指妊娠期发生或发现的糖尿病，妊娠期复杂的代谢改变使糖尿病的控制更复杂化，患者的病理妊娠、分娩期并发症和胎婴儿并发症也明显增高。随着人民生活水平的提高，GDM发病率在全球各地都呈升高趋势。其持续增长的流行病学趋势已构成严重的公共卫生问题，GDM严重威胁着母婴的健康，其影响程度与其发现及治疗时间密切相关。因此，应重视和提高对GDM 的认识，做到早期诊断、早期治疗和适时终止妊娠，可提高母婴预后，减少并发症，降低母婴病死率。
 目的  旨在提高人们对GDM对子代影响的认识，并为今后的研究提供依据。
 方法  收集西安交通大学第一附属医院妇产科2005年1月～2010年10月82例GDM产妇作为研究对象。根据其确诊并开始治疗的时间分为2组，孕周<28周组(32例)和孕周≥28周组(50例)，两组孕妇的年龄、体重、胎产次差异均无显著性(尸<0.05)。从同期住院分娩的正常孕产妇中随机抽取82例作为对照研究。GDM对孕妇围产结局的影响方面比较子痫前期、手术产、羊水过多、产后出血、生殖道感染、羊水过少和胎膜早破的发生率；GDM对围生儿结局的影响方面比较早产、巨大儿、胎儿窘迫、新生儿窒息、新生儿低血糖、高胆红素血症和死胎死产的发生率。
 结果  ①GDM孕妇子痫前期、手术产、羊水过多、产后出血和生殖道感染的发生率与对照组相比差异显著(P<0.05)，而羊水过少和胎膜早破的发生率与对照组相比，差异无显著性(P>0.05)；在孕周>28周组孕妇，手术产、子痫前期、羊水过多、产后出血和生殖道感染的发生率明显高于孕周<28周组孕妇<0.05)。②GDM孕妇新生儿早产、巨大儿、胎儿窘迫、新生儿窒息、新生儿低血糖和高胆红素血症的发生率与对照组相比差异显著（P<0.05），<28周组孕妇巨大儿、新生儿窒息和死胎死产的发生率与对照组相比无显著性差异（P>0.05），而≥28周组孕妇巨大儿、新生儿窒息和死胎死产的发生率与对照组相比差异显著（P<0.05）；在孕周≥28周组孕妇，早产、巨大儿、胎儿窘迫、新生儿窒息、低血糖、高胆红素血症和死胎死产的发生率明显高于孕周<28周组孕妇（P<0.05）。
 结论  孕期应严格控制血糖，积极预防GDM对降低孕产妇病率是非常重要的，早期发现确诊及治疗是有效降低母婴并发症和改善预后的关键。
 
关 键 词：妊娠期；糖尿病；妊娠期糖尿病；围产结局
论文类型：现况调查

Title: Gestational diabetes on maternal and child health and care
ABSTRACT
Background: Gestational diabetes mellitus (GDM) is the occurrence or discovery of diabetes during pregnancy, gestational diabetes, the complex metabolic changes that control is more complicated, the patient's pathological pregnancy, childbirth complications and infant birth complications also significantly increased. With the improvement of living standards, GDM prevalence increasing trend around the world were tested. The epidemiological trend of sustained growth have posed serious public health problem, GDM serious threat to maternal and child health, the influence of time of its detection and treatment are closely related. Therefore, attention should be paid, and raise awareness of GDM, the early diagnosis, early treatment and timely termination of pregnancy can increase maternal and child outcomes, reduce complications, reduce infant and maternal mortality.
Objectives: Aims to increase awareness of the impact of GDM on offspring awareness and provide a basis for future research.
Methods: Collection of First Affiliated Hospital of Xi'an Jiaotong University, Obstetrics and Gynecology in January 2005 ~ October 2010 82 cases of GDM mothers for the study. Diagnosis and begin treatment according to the time divided into 2 groups, gestational age <28 weeks group (32 cases) and gestational age ≥ 28 weeks group (50 cases), two groups of pregnant women's age, weight, parity, there was no significant difference in parity of the (dead <0.05). From the same period of the normal hospital delivery in pregnant women were randomly selected as a control study of 82 cases. Perinatal outcome of GDM in pregnant women compared the impact of preeclampsia, operative delivery, polyhydramnios, postpartum hemorrhage, genital tract infection, oligohydramnios, and the incidence of premature rupture of membranes; GDM on perinatal outcome of children with relatively premature delivery, great children, fetal distress, neonatal asphyxia, neonatal hypoglycemia, hyperbilirubinemia and the incidence of stillbirths.
Results: ① GDM pregnant women, preeclampsia, operative delivery, polyhydramnios, postpartum hemorrhage and the incidence of reproductive tract infections, compared with the control group, significant difference (P <0.05), while too little amniotic fluid and the incidence of premature rupture of membranes and the control group Compared with no significant difference (P> 0.05); in gestational age> 28 weeks group of pregnant women, operative delivery, preeclampsia, polyhydramnios, postpartum hemorrhage and reproductive tract infections were significantly higher than the gestational age <28 weeks Group of pregnant women <0.05). ② GDM pregnant women, premature newborns, great children, fetal distress, neonatal asphyxia, neonatal hypoglycemia, and the incidence of hyperbilirubinemia, compared with the control group, significant difference (P <0.05), <28 week group children of pregnant women huge , Neonatal asphyxia, and the incidence of stillbirths, compared with the control group, no significant difference (P> 0.05), while the great women ≥ 28 weeks group children, neonatal asphyxia, and the incidence of stillbirths, compared with the control group Significant difference (P <0.05); gestational age ≥ 28 weeks group in pregnant women, premature delivery, great children, fetal distress, neonatal asphyxia, hypoglycemia, hyperbilirubinemia and the incidence of stillbirths was significantly higher than the gestational age <28 weeks group of pregnant women (P <0.05).
Conclusion: Blood sugar should be strictly controlled during pregnancy, and actively prevent GDM in reducing maternal morbidity is very important; GDM pregnant women, newborn asphyxia, a huge children the incidence of preterm delivery, fetal distress, neonatal hypoglycemia and hyperbilirubinemia Were significantly higher than non-GDM group; early detection diagnosis and treatment is to reduce maternal complications and improve prognosis. Glucose metabolism in pregnancy is a pregnancy began a period of significant change, this period of monitoring can help the diagnosis of GDM.
 
KEY WORDS: Pregnancy; diabetes; gestational diabetes; perinatal outcome
TYPE OF THESIS: Current Status
目  录
摘　要 I
ABSTRACT III
目  录 V
1 绪论 1
1.1背景及意义 1
1.1.1研究背景 1
1.1.2研究意义 1
1.2研究目的及目标 2
1.2.1研究目的 2
1.2.2研究目标 2
1.3关键词及定义 2
1.3.1妊娠期 2
1.3.2糖尿病 2
1.3.3妊娠期糖尿病 2
1.3.4围产结局 3
1.4文献回顾 3
1.4.1GDM对胎儿和新生儿的影响 3
1.4.2 GDM对子代儿童期的影响 5
1.4.3 GDM对子代青春期和成年期的影响 6
2 研究设计 7
2.1研究设计 7
2.2 研究对象 7
2.3 研究工具 7
2.4 研究步骤 7
2.5统计学分析 7
3 研究结果 9
3.1一般资料 9
3.2妊娠期糖尿病对孕妇围产结局的影响 9
3.3妊娠期糖尿病对围生儿结局的影响 9
4 讨论 11
4.1妊娠期糖尿病对孕产妇的影响 11
4.2妊娠期糖尿病对围生儿的影响 11
4.3两组孕妇母婴结局的差别 12
4.4妊娠期糖尿病的护理 12
4.4.1健康教育 12
4.4.2心理护理 12
4.4.3饮食护理 13
4.4.4适当运动 13
4.4.5定期监测血糖 13
4.4.6胎儿监护 13
4.4.7分娩期护理 13
4.4.8产褥期处理 13
4.4.9新生儿护理 14
5 推论及建议 15
5.1妊娠期糖尿病的预防 15
5.2体会 15
致    谢 17
参考文献 19