目的 基于计划行为理论探讨妊娠期糖尿病（GDM）孕妇自我管理行为意向,为促进其孕期良好的自我管理提供依据。方法 运用质性研究中的现象学研究方法,对12例GDM孕妇进行深度半结构式访谈,并用Colaizzi七步内容分析法对主题进行归纳。结果 根据计划行为理论对主题进行归纳,共提炼出3种类别：①行为态度：认知不足,积极态度,消极态度;②主观规范：家庭影响,医护压力,人际压力;③知觉行为控制：知识技能获取受限,客观条件束缚共8个主题。结论 GDM患者在自我管理过程中存在对疾病认知不足的问题GDM,自我管理行为受到家庭、医护人员、人际关系等外界压力对自我管理态度的影响,且存在知识技能欠缺,客观条件制约多方面阻碍。医护人员应加强对GDM孕妇的自我管理教育,适时提供支持,提高其自我管理效率。

Objective To explore the self-management behavior intention of pregnant women with gestational diabetes mellitus（GDM）based on the theory of planned behavior,and to provide a basis for promoting good self-management during pregnancy. Methods Using the phenomenological research method in qualitative research,12 pregnant women with GDM were interviewed in an in-depth semi-structured interview,and then the themes were summarized by Colaizzi's seven-step content analysis. Results According to the theory of planned behavior,the themes were summarized into three categories and eight themes including（1）Behavioral Attitudes：cognition deficiency,positive attitude,and negative attitude,（2）Subjective norms：family influence,medical pressure,interpersonal pressure,and（3）Perceptual behavior control：self-management knowledge acquisition limitations,self-management Objective conditions constraint. Conclusions Most of the respondents have insufficient awareness of self-management of gestational diabetes,different patients have different attitudes towards self-management,and self-management behavior is affected by external pressures such as family,medical staff,and interpersonal relationships,and there are many obstacles due to a lack of knowledge and skills,Objective conditions．Medical staff should strengthen the self-management education of pregnant women with gestational diabetes,provide timely support,and improve their self-management efficiency．

目的 探究脐动脉血流动力学指标、血脂、促甲状腺激素(TSH)对妊娠期糖尿病患者分娩结局的影响研究。方法 选取我院2021年1月—2021年11月收治的妊娠期糖尿病患者138例,采用随机数字表法分为对照组和研究组,每组各69例。比较2组患者体内脐动脉血流动力学指标、血脂指标及TSH相关指标表达水平差异及妊娠结局,并通过多元线性回归分析探究脐动脉血流动力学指标、血脂指标、TSH等相关指标与妊娠期糖尿病患者不良妊娠结局的相关性。结果 研究组孕妇脐动脉峰值流速/舒张末期流速(S/D)、阻力指数(RI)、三酰甘油(TG)、低密度脂蛋白(LDL)、TSH水平高于对照组,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.05);研究组孕妇巨大儿、剖宫产、新生儿低血糖发生率及新生儿体质量均高于对照组(P<0.05);多元线性回归方程显示:S/D、RI、TG、LDL、TSH水平变化均与不良妊娠结局存在相关性(R²=0.224,调整R²=0.201;F=9.504,P<0. 05),且影响顺序由大到小依次为 TG、TSH、RI、S/D、LDL。结论 妊娠期糖尿病孕妇体内的S/D、RI、TG、LDL、TSH水平异常可能会影响妊娠结局,临床可通过监测上述指标的变化,及时采取干预措施。

Objective To investigate the effects of umbilical artery hemodynamic indexes, blood lipids and thyroid stimulating hormone (TSH) on delivery outcomes in patients with gestational diabetes mellitus. Methods A total of 138 patients with gestational diabetes mellitus who were admitted to our hospital from January 2021 to November 2021 were selected and divided into a control group and a study group by random digital table, with 69 cases in each group. The differences in umbilical artery hemodynamic indexes, blood lipid indexes and TSH-related indexes and pregnancy outcomes were compared between the two groups, and multiple linear regression analysis was used to explore the relationship between umbilical artery hemodynamic indexes, blood lipid indexes, TSH, other related indexes and adverse pregnancy outcomes in patients with gestational diabetes mellitus. Results The systolic and diastolic peak volume ratio (S/D), resistive index (RI) of umbilical artery, triglyceride (TG), low density lipoprotein (LDL) and TSH in the study group were higher than those in the control group, while the levels of free triiodothyronine (FT3) and free thyroxine (FT4) were lower than those in the control group (P<0.05). The incidences of macrosomia, cesarean section, neonatal hypoglycemia and neonatal weight in study group were significantly higher than those in the control group (P<0.05). The multiple linear regression equation showed that the adverse pregnancy outcomes were correlated with changes of TG, TSH, RI, S/D, LDL levels (R²=0.224, adjusted R²=0.201; F=9.504, P<0.05), in descending order. Conclusions Abnormal levels of S/D, RI, TG, LDL, TSH and FT4 in pregnant women with gestational diabetes mellitus may affect the pregnancy outcomes. Clinical intervention measures can be taken by monitoring the changes of the above indicators.

目的 分析宫颈弹性成像(UE)参数在宫颈机能不全(CIC)孕妇妊娠结局中的预测价值。方法 选取我院收治的119例(2019年10月—2021年8月)CIC孕妇,根据妊娠结局分为早产组(孕周＜37周)56例、正常组(孕周≥37周)63例,均于孕20～24周接受阴道超声、宫颈UE检查,获取宫颈长度(CL)、宫颈UE参数[超声弹性对比指数(ECI)、宫颈外口弹性应变率(EOS)、宫颈内口弹性应变率(IOS)]并进行比较,以了解宫颈UE参数在CIC孕妇妊娠结局中的应用价值。结果 早产组CL水平较正常组低,ECI、IOS、EOS水平较正常组高(P＜0.05);单因素分析发现,CL、ECI、IOS、EOS均可对CIC孕妇妊娠结局产生影响(P＜0.05);受试者工作特征(ROC)曲线结果显示,CL、ECI、EOS、IOS预测CIC孕妇早产的AUC分别为0.616、0.765、0.728、0.814,敏感度分别为64.29%、75.00%、73.21%、82.14%,特异度分别为42.86%、52.38%、57.14%、42.86%。结论 宫颈UE参数能有效反映宫颈组织情况,对CIC孕妇妊娠结局具有一定的预测价值。

目的 研究不同孕周妊娠期肝内胆汁淤积症（ICP）产妇胆汁酸、肝酶、α-羟丁酸脱氢酶（α-HBDH）水平与围产儿结局关系。方法 采用病例对照研究方法,选取孕中期和晚期ICP组、对照组为研究对象。生化仪检测总胆汁酸（TBA）、血清肝酶、α-HBDH水平。高效液相色谱串联质法检测血清内胆酸（CA）、鹅脱氧胆酸、脱氧胆酸（DCA）、石胆酸（LCA）等游离胆汁酸含量。结果 孕中期ICP组血清内CA、DCA、LCA、TBA丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）均大于孕晚期组,差异有统计学意义（P<0.05）。多因素Logistic 回归分析结果显示：ALT、AST、a-HBDH、CA、DCA、LCA和TBA升高是围产儿不良结局的危险因素。结论 各类胆汁酸、肝酶、α-羟丁酸脱氢酶对围产儿结局预测价值不同。ALT、AST、a-HBDH、CA、DCA、LCA和TBA升高是围产儿不良结局的危险因素。

目的 探讨子宫瘢痕的超声弹性成像结合厚度分析对剖宫产后再妊娠产妇子宫破裂的预测应用。方法 选择2020年1月—2021年12月在中山市中医院分娩的剖宫产术后再次妊娠经阴道分娩（VBAC）产妇作为研究对象。根据纳入和排除标准,共纳入子宫破裂的VBAC产妇32例、非子宫破裂的VBAC产妇90例。通过住院病历信息系统查询研究对象的基本信息及其在妊娠晚期（≥37周）用B超对研究对象行子宫瘢痕厚度和弹性的测量结果,采用受试者工作特征曲线（ROC）曲线分析子宫瘢痕厚度和弹性SI值对子宫破裂的预测作用。结果 子宫破裂组中年龄>35岁、妊娠>2次、与上次剖宫产间隔<2年、新生儿体质量≥3 kg、单层缝合者的比例高于非子宫破裂组（P<0.05）。122例产妇子宫瘢痕厚度的均值为（3.42±0.49）mm,SI的均值为（2.57±0.45）。ROC曲线分析结果显示：子宫瘢痕厚度单独预测子宫破裂的曲线下面积（AUC）为0.805（95%CI：0.730~0.880,P<0.05）,cut off值为3.05 mm,灵敏度为0.726,特异度为0.910,约登指数为0.636;子宫瘢痕SI单独预测子宫破裂的AUC为0.730（95%CI：0.635~0.824,P<0.05）,cut off值为2.11,灵敏度为0.767,特异度为0.781,约登指数为0.548;子宫瘢痕厚度联合预测子宫破裂的AUC为0.874（95%CI：0.812~0.937,P<0.01）,灵敏度为0.875,特异度为0.811,约登指数为0.686。子宫瘢痕厚度结合子宫瘢痕SI值预测子宫破裂的AUC高于单独使用子宫瘢痕厚度（Z=7.611,P=0.041）和子宫瘢痕SI值（Z=25.864,P=0.025）。结论 子宫瘢痕的超声弹性成像SI值联合子宫厚度可有效提高超声对于VBAC产妇子宫破裂的预测效能,具有一定的应用意义。

Objective To study the application of ultrasound elasticity imaging combined thickness analysis of uterine scar in predicting uterine rupture in women pregnant after cesarean section．Methods Pregnant women with vaginal birth after cesarean（VBAC）from January 2020 to December 2021 in Zhongshan Hospital of Traditional Chinese Medicine were selected as the research subjects．A total of 32 VBAC parturients with uterine rupture and 90 VBAC parturients without uterine rupture were included according to the inclusion and exclusion criteria．The basic information of the subjects was queried through the medical record information system of the hospital．In the third trimester（≥37 weeks）,the thickness and elasticity of uterine scar were measured by ultrasound,and the predictive effect of uterine scar thickness and elastic SI value on uterine rupture was analyzed by ROC curve．Results Chi-square test showed that the incidence of uterine rupture was higher in patients with age>35 years,pregnancy>2 times,interval from last cesarean section<2 years,newborn weight≥3kg,and the proportion of uterine rupture in single suture was higher than that in double suture（P<0.05）．The mean uterine scar thickness of 122 subjects was（3.42±0.49）mm,and the mean SI was（2.57±0.45）．The area under curve（AUC）of uterine scar thickness alone for predicting uterine rupture was 0.805（95%CI：0.730-0.880,P<0.05）,the cut off value was 3.05 mm,the sensitivity was 0.726,the specificity was 0.910,and the Youden coefficient was 0.636 by ROC curve analysis．The AUC of uterine scar SI alone for predicting uterine rupture was 0.730（95%CI：0.635-0.824,P<0.05）,the cut off value was 2.11,the sensitivity was 0.767,the specificity was 0.781,and the Youden coefficient was 0.548 by ROC curve analysis．The AUC of uterine scar thickness combination for predicting uterine rupture was 0.874（95%CI：0.812-0.937,P<0.01）,the sensitivity was 0.875,the specificity was 0.811,and the Youden coefficient was 0.686 by ROC curve analysis．The AUC predicted by uterine scar thickness combined with uterine scar SI value was higher than that predicted by uterine scar thickness alone（Z=7.611,P=0.041）and uterine scar SI value（Z=25.864,P=0.025）．Conclusions Elastic SI value of ultrasound imaging of uterine scar combined with uterine thickness can effectively improve the prediction efficiency of ultrasound for VBAC maternal uterine rupture,which has certain application significance,but further demonstration is still needed．

目的 探讨慢性乙型肝炎病毒（HBV）感染对妊娠期糖尿病（GDM）孕妇的妊娠并发症、孕晚期生殖道B族链球菌（GBS）感染情况以及妊娠结局的影响。方法 选取2020年1月1日—12月31日在广州市妇女儿童医疗中心定期产检、足月、单胎妊娠的GDM孕妇共583例,其中合并HBV感染者（GDM+HBV组）48例,无合并者（GDM组）535例。比较2组的妊娠期并发症、妊娠晚期（妊娠35~37周）生殖道GBS感染情况、妊娠结局以及阴道分娩者的母儿结局。结果 与GDM组患者相比,GDM+HBV组患者出现妊娠期肝内胆汁淤积症、孕晚期生殖道GBS感染者比例较高,孕期出现胎盘早剥者比例较高,阴道分娩过程中出现产时发热、羊水粪染和新生儿入住NICU者比例均较高（均P<0.05）。结论 与无合并慢性HBV感染的GDM患者相比,合并慢性HBV感染的GDM患者在围产期的母儿风险升高。

Objective To investigate the effects of chronic hepatitis B virus（HBV）infection on pregnancy complications,group B streptococcus（GBS）infection in third trimester and pregnancy outcome in pregnant women with gestational diabetes mellitus（GDM）．Methods A retrospective study of 583 pregnant women with GDM,singleton gestation and cephalic presentation delivered at term in Guangzhou Women and Children’s Medical Center was carried out．Including 48 GDM women complicated with chronic HBV infection（GDM+HBV group）and 535 GDM women without HBV infection（GDM group）．Pregnancy complications,GBS infection in third trimester（gestation 35-37 weeks）,pregnancy outcomes,maternal and neonatal outcomes of vaginal delivery were compared between the two groups．Results GDM+HBV group had a higher proportion of intrahepatic cholestasis of pregnancy（ICP）and GBS infection in third trimester than GDM group,and a higher proportion of placental abruption during pregnancy．GDM+HBV group showed a significantly increased proportion in intrapartum fever,meconium-stained amniotic fluid and neonatal intensive care unit admission during vaginal delivery than GDM group（all P<0.05）．Conclusions GDM women with chronic HBV infection are associated with increased maternal and fetal risk during pregnancy and delivery．

目的 本文主要对接受两种不同的甲氨蝶呤治疗方式与腹腔镜保守治疗输卵管妊娠患者治疗效果进行比较,了解不同治疗方案所具有的优势。方法 选择参与者为收治的输卵管妊娠患者200例(时间选择:2018年1月—2020年12月),以治疗方案进行分组(共2组,各100例)。对照组进行腹腔镜下输卵管线性切开术治疗,术中应用甲氨蝶呤治疗;研究组在术前进行甲氨蝶呤肌注,48小时后进行腹腔镜输卵管线性切开术治疗;比较治疗结果。结果 2组输卵管通畅率、术后持续异位妊娠率比较有差异,2组比对有统计学意义(P<0.05)。 2组手术指标(手术时长、术中出血量、β-hCG恢复至正常时间)比较有差异,2组比对有统计学意义(P<0.05)。结论 输卵管妊娠患者选择腹腔镜下输卵管线性切开术治疗时联合术前肌注甲氨蝶呤或术中应用甲氨蝶呤治疗,均可有助于输卵管妊娠症状的进一步缓解。但在此次治疗中患者术前接受甲氨蝶呤肌注+腹腔镜输卵管线性切开术联合治疗取得的疗效比常规的术中应用甲氨蝶呤更具有治疗优势,患者手术时长明显缩短,术中出血量明显降低,有效的避免反复电凝止血造成对输卵管造成的伤害,对输卵管功能进行有效保护,可推广。

目的 分析曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗卵巢子宫内膜异位囊肿(OEC)患者的效果。方法 选取我院2019年1月—2020年5月期间收治的OEC患者108例,采用随机抽签法分成研究组与对照组,各54例。对照组行腹腔镜下卵巢囊肿剥除术治疗,研究组基于对照组加用曲普瑞林治疗,统计对比2组疗效、妊娠率以及术前、术后6个月、1年血清性激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、抗苗勒管激素(AMH)]、血清高迁移率组蛋白B1(HMGB1)、视黄醇结合蛋白4(RBP4)、糖类抗原125(CA125)水平。结果 研究组治疗总有效率92.59%高于对照组75.93%(P＜0.05);术后6个月、1年研究组LH、FSH低于对照组,AMH高于对照组(P＜0.05);术后6个月、1年研究组CA125、RBP4、HMGB1低于对照组(P＜0.05);研究组妊娠率59.26%高于对照组29.63%(P＜0.05)。结论 曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗OEC患者时,可改善性激素水平,提高妊娠率,降低血清CA125、RBP4、HMGB1水平。

目的 本项目主要探究关于妊娠期妇女肛肠疾病的患病现状和危险因素分析,为减少妇女在妊娠阶段肛肠疾病的发病几率,有效预防疾病发生提供参考建议。方法 本研究主要采用现况研究,以2020年5月1日—2021年5月在本院就诊的妊娠妇女患者633例作为研究对象。采用现况调查,对研究对象进行临床检查和问卷调查。临床检查为肛肠科检查,包括肛门视诊、肛门直肠指诊检查、肛门镜检查等。问卷调查主要包括五个部分,第一部分为基础资料,包括年龄,居住地(农村/城市),学历、怀孕次数,怀孕时间,流产次数;第二部分为饮食习惯;第三部分为生活习惯和方式;第四部分为肛肠疾病患病信息;第五部分为孕产妇心理焦虑调查量表。使用SPSS、SAS统计学软件对患者数据进行分析,使用t检验和单因素方差分析检测数据之间的差异性,使用多元Logistic回归对危险因素进行分析。结果 通过对妊娠妇女进行肛肠检查,根据临床肛肠疾病诊断标准得知,633名妊娠妇女中,共有437名,患病率为69.03%;根据疾病种类进行分类得知,单纯性疾病:便秘患者156例、痔疮患者105例、肛裂患者35例、肛周脓肿患者29例、直肠脱垂24例、直肠息肉15例、直肠阴道瘘10例;合并疾病:肛裂合并痔疮43例;肛肠类癌症疾病:无;根据数据分析结果得知:633名妊娠妇女中,共有437名,患病率为69.03%;根据差异性分析,肛肠疾病患病率在不同年龄、居住地、生产次数、流产次数、饮食习惯、运动量、饮酒史、焦虑状况等因素之间有统计学差异(P<0.05),在不同学历、吸烟史、睡眠时间之间无统计学差异(P>0.05);经过采用多元Logistic回归分析,结果显示,年龄、生产次数、流产次数、食物喜好、使用水果蔬菜的频率、每日运动量、饮酒史、焦虑状况等是造成妊娠期妇女肛肠疾病发病的独立危险因素。结论 造成妊娠期妇女肛肠疾病的发病的主要影响因素为年龄、居住地、怀孕次数、孕期、流产次数、饮食习惯、运动量、焦虑状况,应该针对以上因素进行防范,有效减少发病率。

目的 对比剖宫产术后子宫瘢痕妊娠(CSP)与对照组的相关数据,为及早诊断CSP提供帮助;对比不同超声分型CSP超声特征及治疗方式,为早期诊断和个体化治疗方案的制定提供客观依据。方法 回顾性分析我院收治的41例CSP患者及41例对照患者的超声声像图特征及相关临床指标,总结分析不同分型CSP患者所采取的治疗方式。结果 41例CSP患者与41例对照组比较,出现阴道流血的概率更高,差异有统计学意义(P<0.05);根据超声分型将CSP分为4型,分别为Ⅰ、Ⅱ、ⅢA及ⅢB型,Ⅰ型CSP患者与其他3型CSP比较,出现阴道流血的概率要高,差异有统计学意义(P<0.05);Ⅰ型CSP较Ⅱ、Ⅲ、ⅢA型子宫前壁肌层厚,差异有统计学意义(P<0.05);关于治疗:Ⅰ型CSP主要治疗方式为超声引导清宫术;Ⅱ型根据临床实际情况,每一种方式都可选择;Ⅲ型CSP主要采用子宫动脉栓塞后超声引导下清宫术,所有患者术中出血均不多,预后良好并顺利出院。结论 1.CSP患者与对照组临床指标对比有一定差异性,但不够特异,故为了及早的诊断CSP,对于有剖宫产史妇女再次妊娠的早孕检查,一定要明确妊娠囊与子宫前壁下段瘢痕及膀胱的关系;2.超声分型有助于制定针对CSP的个体化治疗方案,以改善患者预后。故诊断CSP的同时,还需对CSP进行准确的超声分型。

Objective To compare the data of cesarean scar pregnancy (CSP) after cesarean section with that of the control group, so as to provide help for the early diagnosis of CSP. To compare the ultrasonic characteristics and treatment methods of different ultrasonic types of CSP, so as to provide an objective basis for early diagnosis and individualized treatment. Methods The ultrasonographic features and related clinical indexes of 41 CSP patients and 41 control patients were analyzed retrospectively, the treatment methods adopted by patients with different types of CSP were summarized and analyzed. Results The probability of vaginal bleeding in 41 patients with CSP was higher than that in 41 control patients, the difference was statistically significant (P<0.05). According to ultrasonic classification, CSP is divided into four types: Ⅰ, Ⅱ, ⅢA and ⅢB. Compared with other 3 types CSPs, patients with type Ⅰ CSP had higher probability of vaginal bleeding, which difference was statistically significant (P<0.05). The main treatment of type Ⅰ CSP was ultrasound-guided uterine curettage, each method could be selected according to the actual clinical situation for type Ⅱ CSP, type Ⅲ CSP mainly adopted ultrasound-guided uterine curettage after uterine artery embolization. All patients had little intraoperative bleeding, good prognosis and been discharged successfully. Conclusions There were some differences in clinical indexes between CSP patients and control patients, but they were not specific enough. Therefore, in order to diagnose CSP as soon as possible, for the early pregnancy examination of second pregnancy in patients with cesarean section, we must clarify the relationship between gestational sac and scar of the lower part of the anterior wall of uterus and bladder. Ultrasound typing is helpful to formulate an individualized treatment plan for CSP patients to improve the prognosis. Therefore, accurate ultrasonic typing is also needed when diagnosing CSP.