北京地区巨大儿高危因素及并发症分析

摘要

Objective To investigate the risk factors and complications of macrosomia and analyze the influential extent of the high risk factors on macrosomia in Beijing area.Methods Six hundreds and seven neonates selected randomly were divided into two groups, and consisting of the macrosomia group (297 cases with the birth weight ≥ 4 000 g)and the control group (310 cases with the birth weight of 2500 - ＜ 4 000 g).All data were analyzed by the use of the Logistic refression in the SAS 9.1 software.Results The maternal weight gain during pregnancy was significantly higher in the macrosomia group (21.6 ± 5.9 kg) than that in the control group (14.7 ± 5.7 kg) (t= 14.782, P ＜ 0.01).The results of Logistic regression indicated that the main high-risk factors of macrosomia were biparietal diameter (BPD)under B-ultrasound (OR = 341.327) and the maternal weight gain during pregnancy (OR = 70.352).There was a higher rate of the cesarean section in the macrosomia group (56.2％) compared to that in the control group (13.9％) (P ＜0.01).The average volume of the postpartum hemorrhage in macrosomia group (235.47 ± 82.23 ml) were significantly higher than that in the control group (92.81 ± 45.59 ml) (P ＜ 0.01).Conclusions The prevalence of the macrosomicis related to the BPD under B-ultrasound, maternal weight gain during pregnancy, gravidity and parity, delivery mode and newborn gender, in particular the BPD and the maternal weight gain during pregnancy are the most influential factors.There usually is a higher rate of the cesarean section and the complications are common seen in macrosomic infants.%目的 探讨北京地区巨大儿的高危因素及并发症,分析各高危因素的权重,即影响程度.方法 随机选择607例病例,分为巨大儿组(297例,体质量≥ 4 000 g)和对照组(310例,2 500 g ＜体质量＜ 4 000 g).使用SAS 9.1统计软件,应用Logistic多元逐步回归方法进行数据分析.结果 巨大儿组母亲孕期增重(21.6 ± 5.9)kg,正常对照组增重(14.7 ± 5.7) kg,两组比较有统计学意义(P ＜ 0.01).Logistic回归分析显示,B超下胎儿双顶径(OR ＝ 341.327)、母亲妊娠期增重(OR ＝ 70.352)是巨大儿的主要高危因素.巨大儿组56.2%的剖宫产率较对照组的13.9%有统计学意义(P ＜ 0.01).巨大儿组母亲产后平均出血量为(235.47 ± 82.23) ml,对照组为(92.81 ± 45.59) ml,差异有统计学意义(t ＝ 7.68,P ＜ 0.01).结论 母亲孕期增重、妊产次、分娩方式、新生儿性别、B超下胎儿双顶径与巨大儿的发生有相关性,B超下胎儿双顶径的影响程度最大,其次为母亲妊娠期增重.巨大儿组较对照组剖宫产和新生儿并发症的发生率高.