高龄妊娠期糖尿病孕妇妊娠结局及产后发生深静脉血栓的影响因素分析

Analysis on the pregnancy outcome of elderly pregnant women with gestational diabetes mellitus and the influencing factors of postpartum deep vein thrombosis

目的分析高龄妊娠期糖尿病(GDM)孕妇妊娠结局及产后发生深静脉血栓的影响因素。方法选取2020年1月—2023年1月在丽水市人民医院分娩的125例高龄GDM孕妇为研究组,70例正常分娩的高龄孕妇为对照组。观察两组妊娠结局、神经发育评分,分析高龄GDM孕妇深静脉血栓发生情况。结果与对照组相比,研究组剖宫产(17.14%vs.38.40%)、早产(4.29%vs.14.40%)、巨大儿(2.86%vs.11.20%)发生率均较高(均P<0.05)。与对照组相比,研究组新生儿行为能力评分[(10.72±0.48)分vs.(10.08±0.31)分]、原始反射评分[(5.98±0.44)分vs.(5.41±0.40)分]、被动肌张力评分[(7.56±0.51)分vs.(6.25±0.42)分]、主动肌张力评分[(7.81±0.81)分vs.(6.32±0.72)分]、一般情况评分[(6.82±0.71)分vs.(5.21±0.66)分]及新生儿行为神经测定(NBNA)量表总分[(38.89±1.01)分vs.(33.27±1.10)分]均较低(均P<0.05)。研究组中,发生深静脉血栓31例。多因素logistic回归分析显示:年龄、盆腔感染史、内科合并症、久坐≥3 d、下肢静脉曲张、妊娠期高血压疾病、胎盘早剥、子痫前期、下肢感染史、吸烟史、产后出血是高龄GDM孕妇发生产后深静脉血栓的影响因素(均P<0.05)。结论年龄、盆腔感染史、内科合并症、久坐≥3 d、下肢静脉曲张、妊娠期高血压疾病、胎盘早剥、子痫前期、下肢感染史、吸烟史、产后出血是高龄GDM孕妇产后发生深静脉血栓的影响因素,根据影响因素对其进行干预、控制,可减少深静脉血栓的发生。

Objective To analyze the pregnancy outcome of elderly pregnant women with gestational diabetes mellitus(GDM)and the influencing factors of postpartum deep vein thrombosis.Methods A total of 125 elderly pregnant women with GDM who gave birth to their babies in Lishui People's Hospital from January 2020 to January 2023 were selected as study group,and 70 elderly pregnant women of normal childbirth were selected as control group.The pregnancy outcomes and neurodevelopmental scores of the two groups were observed,and the occurrence of deep vein thrombosis in elderly pregnant women with GDM was analyzed.Results Compared with control group,the incidence rates of cesarean section(17.14%vs.38.40%),preterm delivery(4.29%vs.14.40%),macrosomia(2.86%vs.11.20%)were higher in study group(P<0.05).Compared to control group,the scores of behavioral ability(10.72±0.48 vs.10.08±0.31),primitive reflex(5.98±0.44 vs.6.25±0.42),passive muscle tone(7.56±0.51 vs.6.25±0.42),active muscle tone(7.81±0.81 vs.6.32±0.72),general condition(6.82±0.71 vs.5.21±0.66),and total score of neonatal behavioral neurological assessment(NABA)(38.89±1.01 vs.33.27±1.10)were lower in study group(P<0.05).In study group,31 cases were found with deep vein thrombosis.Multivariate logistic regression analysis showed that age,history of pelvic infection,medical complications,sedentary≥3 days,varicose veins of lower extremity,hypertensive disorder complicating pregnancy,premature placental dissection,preeclampsia,history of infection of lower extremity,smoking history,and postpartum hemorrhage were the main factors affecting postpartum deep vein thrombosis in elderly pregnant women with GDM(P<0.05).Conclusion Age,history of pelvic infection,medical complications,sedentary≥3 days,varicose veins of lower extremity,hypertensive disorder complicating pregnancy,premature placental dissection,preeclampsia,history of infection of lower extremity,smoking history,and postpartum hemorrhage are the main factors affecting postpartum deep vein thrombosis in elderly pregnant women with GDM.Intervention and control should be carried out according to the influencing factors to reduce the occurrence of deep vein thrombosis.