92例巨大兒相關因素分析及干預措施對剖宮產分娩巨大兒的必要性

李早紅　林桂梅　蘇芳芳

【摘要】 目的：探討巨大兒發生的危險因素，以便及早采取有效措施以降低巨大兒發生率，并探討采用干預措施對剖宮產分娩巨大兒的必要性。方法：選取2015年3月-2016年2月期間本院產科門診定期產檢并于手術室行剖宮產的孕婦394例，回顧性的收集其既往資料。根據胎兒出生體重將孕婦分為巨大兒組92例及正常組302例，分析巨大兒發生的相關因素。結果：孕前體型越重，孕期體重總增長越多，會增加巨大兒發生的風險。同時，孕36周胎兒的雙頂徑及腹圍越大，發生巨大兒的風險也越高，當雙頂徑達到9.4 cm時，該風險值為2.284，當腹圍達到34.0 cm時，該風險值為4.338。結論：應當將整個孕期體重控制在18 kg以內，尤其是針對孕前體型超重的孕婦，更應當控制其體重的增長。規范的飲食指導，能降低妊娠期糖尿病孕婦巨大兒的發生率。當36周胎兒的雙頂徑、腹圍分別超過9.4 cm及34.0 cm時，應當及早控制飲食，以減少巨大兒發生的風險。巨大兒行剖宮產術的孕婦得到規范的護理干預后，可以有效減少各種并發癥及不良反應的發生。

【關鍵詞】 巨大兒； 相關因素； 干預措施； 剖宮產

【Abstract】 Objective：To discuss about the risk factors of the macrosomia so as to do effective intervention measures to reduce the occurrence rate of the macrosomia and to discuss the necessity of the interventions for those macrosomia during caesarean operation.Method：From March 2015 to February 2016，394 pregnant women who accepted the caesarean operation in the operation room were collected，the pregnant womens informations were retrospectively collecting.By the bodyweight of the infant，the pregnant women were divided into the macrosomia group of 92 cases and the normal group of 302 cases to analyze the relationship between the risk factors and the macrosomia.Result：The occurrence of the macrosomia may correlate to the larger BMI before pregnancy and the bodyweight gain during the whole pregnancy.Meanwhile，with the higher level of the bipariteal diameter and the abdominal circumference of the fetal in the 36th week，the higher occurrence rate of the macrosomia will exist，when the bipariteal diameter up to 9.4 cm，the OR value was 2.284，when the abdominal circumference up to 34.0 cm，the OR value was 4.338.Conclusion：We should help the pregnant women to control their bodyweight gain lower than 18 kg during the whole pregnancy，especially for those pregnant women whose BMI was over 24.0 kg/m2 before the pregnancy.The nutritional therapy can reduce the occurrence rate of the macrosomia for those gestational diabetes mellitus pregnant women.If the bipariteal diameter of the fetal up to 9.4 cm or the abdominal circumference up to 34.0 cm，the pregnant women should control their diet in order to reduce the risk of the macrosomia.For those macrosomia，we apt to do the caesarean operation on the pregnant women.Of course，if we operated some intervention measures correctly，we can reduce the occurrence of the complications and the untoward effects.

【Key words】 Macrosomia； Risk factor； Intervention measures； Caesarean operation

First-authors address：The Maternal and Child Health Hospital in Xiamen，Xiamen 361001，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.25.013

出生體重達到或超過4000 g的新生兒稱為巨大兒。有研究顯示，近年來巨大兒的發生率呈上升趨勢[1-2]，其會增加圍產期并發癥的發生率，如產后出血、難產、產傷的危險性增高，并對胎兒成年以后的遠期并發癥，如糖尿病、肥胖等的發病風險帶來影響，另外，巨大兒以手術分娩方式的可能性較大[3]，也增加了患者的經濟負擔?！?br>