超声多参数在预测妊娠期糖尿病巨大儿分娩方式中的临床价值

摘要 目的：探究超声多参数在预测妊娠期糖尿病巨大儿分娩方式中的应用价值。方法：选择2016年2月至2020年9月于中国人民解放军联勤保障部队第九○一医院（我院）分娩的156例妊娠期糖尿病产妇为研究对象，回顾性分析其一般临床指标及多普勒超声检测参数，按照新生儿是否为巨大儿区分为巨大儿组（52例）和非巨大儿组（104例），对比两组胎儿超声参数差异，评估胎儿双顶径（biparietal diameter，BPD）、头围（head circumference，HC）、腹围（abdominal circumference，AC）及股骨长度（femur length，FL）与新生儿体重的相关性，纳入年龄、宫高、孕妇腹围、孕妇体重、BPD、HC、AC、FL等指标评估巨大儿单因素影响因素，最后多因素Logistic回归分析探究巨大儿独立危险因素。结果：（1）比较显示巨大儿组胎儿BPD、HC、AC和HL均大于非巨大儿组（P<0.05）；（2）Spearman相关性分析显示BPD、HC、AC和HL均与新生儿体重呈正相关（P<0.05）；（3）分析显示产妇宫高、产妇腹围、孕期增重、BPD、HC、AC和HL均为巨大儿单因素影响因素（P<0.05）；（4）Logistic多因素回归分析显示孕妇宫高、BPD、HC、AC为巨大儿独立危险因素。结论：孕期使用超声多参数对妊娠期糖尿病产妇巨大儿发生情况具有较好的预测价值，可协助医师了解胎儿相关指标，并据此选择合适的分娩方式，值得临床推广应用。

The Clinical Value of Multi Parameter Ultrasound in Predicting Delivery Mode of Macrosomia with Gestational Diabetes Mellitus

ABSTRACT Objective: To explore the value of multi-parameters ultrasound in predicting the delivery mode of gestational diabetes mellitus (gdm) macrosomia. Methods: 156 parturients with gestational diabetes mellitus from february 2016 to september 2020 in our hospital were selected as the research subjects. The general clinical indicators and doppler ultrasound parameters were retrospectively analyzed. According to whether the newborn was a macrosomia, it was divided into macrosomia group (52 cases) and non-macrosomia group (104 cases). The differences of fetal ultrasound parameters between the two groups were compared. To evaluate the correlation between fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femoral length (FL) and neonatal weight, and incorporate such indicators as age, uterine height, pregnant women''s abdominal circumference, pregnant women''s weight, BPD, HC, AC, and FL to evaluate the univariate factors of macrosomia. Finally, multivariate Logistic regression analysis was used to explore the independent risk factors of macrosomia. Results: (1) Comparison showed that the fetal BPD, HC, AC and HL in the macrosomia group were larger than those in the non-macrosomia group (P<0.05). (2) Spearman''s correlation analysis showed that BPD, HC, AC and HL were positively correlated with neonatal weight (P<0.05). (3) That analysis show that maternal uterine height, maternal abdominal circumference, weight gain during pregnancy, BPD, HC, AC and HL were the single factor affect macrosomia (P<0.05). (4) Logistic regression analysis showed that uterine height, BPD, HC and AC were the independent risk factors for macrosomia. Conclusion: Multi-parameters ultrasound during pregnancy has a good value in predicting the incidence of macrosomia in pregnant women with gestational diabetes, which can help doctors to understand the relevant indicators of the fetus and select the appropriate mode of delivery accordingly, worthy of clinical application.