某医院599例早产病例临床特征分析

发布时间：2018-05-08 11:27

本文选题：早产 + 临床特征　；参考：《第三军医大学》2015年硕士论文

【摘要】：研究背景:在产科的并发症里,早产是比较常见的,早产儿容易发生各种近期和远期并发症,近期如缺氧缺血性脑病、ARDS、各种感染等,远期如慢性肺疾病、小儿大脑性瘫痪、失明(主要由于视网膜病变所致)、智力缺陷等等。早产儿在治疗和护理方面的花费都比较高,患儿家长乃至整个家庭都要承受非常大的经济负担,同时还要遭受精神上的折磨。早产是一个多因素导致的病症,病因复杂,早产的防治一直是产科界的一个重要课题,。近20年来早产领域的科技进步主要体现在早产的预测、早产分娩前应用肾上腺皮质激素促胎肺成熟,减少早产儿的呼吸窘迫综合症等疾病的发生、宫缩抑制剂的治疗、孕激素对早产高危孕妇的预防作用及儿科早产重症监护技术的进步等。尽管如此,早产发生率仍然呈现上升趋势,并且已经成为发达社会的公共卫生问题,在中国随着国民经济水平和生活水平的提高,早产及早产儿相关问题越来越凸显出来并且也越来越受到重视。研究目的:通过对早产住院分娩病例临床特征的分析,了解早产的临床特征及流行病学特征;探讨引起早产的原因及早产儿窒息的相关高危因素;为开展早产的预防控制提供科学依据,以期降低早产的发生。研究方法:本课题拟收集某三甲医院2007年~2012年收治的早产住院分娩病例,通过对病例的临床特征分析,了解早产的流行病学特征,运用spss19.0软件进行数据整理和?2检验,探讨引起早产的原因及早产儿窒息的相关高危因素;为早产的预防提供科学依据,以期降低早产的发生。结果:1、数据的收集时间为2007年1月—2012年12月共6年,共纳入住院分娩病历12637例,其中早产患者病例599例。6年期间该院早产率分别为6.2、5.4、5.7、4.6、4.5及3.9%,2007年最高(6.2%),2012年最低(3.9%),随着时间的增加,有下降趋势。2、晚期早产构成比最高(74.5%);其次是中期(14.4%)和早期(10.0%),极早早产最低(1.2%);治疗性早产平均比率65.4%,高于非治疗组(34.6%)。3、早产病例母体因素分布特征:(1)怀孕次数≥3次的早产占比46.6%,明显高于1、2孕次的28.4%和25.0%;(2)早产妇中有流产史的患者约有65%,流产史中采取手术方式(51.9%)最多;(3)年龄因素:2012年小于18岁和大于40岁组的早产率为12.5%(2/16),与其它年龄组(均值为3.8%)相比较高。(4)早产妇的妊娠合并症前3位分别为妊娠期糖尿病(15.0%)、贫血(9.7%)、乙型病毒性肝炎(6.0%)。(5)早产妇的妊娠并发症前3位分别为胎膜早破(42.4%)、妊娠期肝内胆汁淤积症(ICP)(16.7%)、胎盘前置(9.7%)。4、早产群体的胎儿因素分布特征(1)早产病例里,胎儿肩先露(2.0%)、臀先露(9.0%)的值显著高于正常新生儿文献值。(2)有1.3%的羊水过多,5.1%的羊水过少,和文献报道水平相比,稍高。(3)早产儿的体质量小于2500g者约有43%。(4)有10.0%属于多胎妊娠,远高于国内外的报道水平(2-3%);25.9%的研究对象发生脐带绕颈,与文献报道水平(13~25%)相比更高。(5)晚期早产儿阿普加1min评分8—10分(正常)的构成比率91.7%,远高于极早(60.6%)和早期早产儿(82.6%)组,且无死亡。5、早产组与非早产组人均住院时间和住院总费用的比较明显增加6、早产儿窒息的相关危险因素早产是多因素共同作用的结果,从分析中看出孕周、并发症、宫内窘迫,出生体重为早产儿窒息的相关危险因素。结论:6年来,随着时间的增加,受孕期保健措施干预过的住院分娩者,其早产率有下降趋势,其中以治疗性早产较多,同时妊娠并发症高,迫切需要防控;一些分布特点可能是早产的危险因素,其中母体因素包括:流产史,18岁和40岁年龄,合并糖尿病、贫血、乙型病毒性肝炎,胎膜早破,妊娠胆淤症,前置胎盘;子体因素包括:臀先露或肩先露,羊水异常,多胎妊娠,脐带绕颈等。
[Abstract]:Background: preterm birth is more common in obstetric complications. Premature infants are prone to a variety of short-term and long-term complications, such as hypoxic-ischemic encephalopathy, ARDS, various infections, such as chronic lung disease, cerebral palsy in children, blindness (mainly due to retinopathy), mental defects and so on. Preterm infants are treated and protected. Children's parents and even the whole family have to bear a great economic burden and suffer from mental suffering. Premature birth is a multifactor cause, the cause of which is complicated. The prevention and treatment of premature birth has been an important issue in the obstetrics field. The progress of science and technology in the field of preterm labor in the past 20 years is mainly reflected in the progress of science and technology. Preterm labor predicts the use of corticosteroids to promote fetal lung maturation before delivery, reducing the incidence of premature infants with respiratory distress syndrome, the treatment of uterine contraction inhibitors, the preventive effect of progestin on preterm pregnant women and the progress of the pediatric preterm intensive care technology, although the incidence of premature birth still increases. It has become a public health problem in the developed society. With the improvement of the level of national economy and the improvement of living standards in China, the problems related to preterm and premature birth are becoming more and more prominent and more and more important. A study of the causes of preterm birth and the related risk factors for preterm birth asphyxia; to provide scientific basis for the prevention and control of premature delivery in order to reduce the occurrence of premature birth. Research methods: this subject is to collect cases of premature delivery in a certain hospital in ~2012 in 2007, and to understand the clinical features of the cases and understand the clinical characteristics of the cases. The epidemiological characteristics of preterm birth, using spss19.0 software for data sorting and 2 tests, to explore the causes of preterm birth and related risk factors for premature birth asphyxia; provide a scientific basis for preterm birth prevention in order to reduce the occurrence of preterm labor. Results: 1, the data collection time was from January 2007 to December 2012 for a total of 6 years and included inpatient delivery in hospital. 12637 cases of the case history, of which 599 cases of premature delivery were.6 and 3.9%, the highest (6.2%) in 2007 (6.2%) and the lowest (3.9%) in 2012. With the increase of time, the decline trend was.2, the late preterm birth ratio was the highest (74.5%); the second was the middle (14.4%) and early (10%), the lowest (1.2%); and the treatment early. The average yield ratio was 65.4%, higher than that of non treatment group (34.6%).3, the distribution characteristics of maternal factors in premature cases were: (1) the number of preterm births with more than 3 times of pregnancy accounted for 46.6%, significantly higher than 28.4% and 25% of 1,2 pregnancies; (2) there were about 65% in women with a history of abortion in early parturients and most in abortion history (51.9%); (3) age factors were less than 18 and big in 2012. The preterm birth rate in the 40 year old group was 12.5% (2/16), compared with the other age groups (mean 3.8%). (4) the first 3 prepregnancy complications were gestational diabetes (15%), anemia (9.7%), and viral hepatitis B (6%). (5) 3 of early maternal pregnancy were prematurely premature rupture of membranes (42.4%) and intrahepatic cholestasis of pregnancy (ICP). 16.7%) placenta previa (9.7%).4, the distribution characteristics of fetal factors in preterm population (1) preterm birth cases, fetal shoulder first exposure (2%), gluteus exposure (9%) significantly higher than the normal neonatal literature value. (2) 1.3% amniotic fluid is too much, 5.1% amniotic fluid is too little, slightly higher than the literature level. (3) there is about 43%. (4) in the body mass less than 2500g in preterm infants. 10% were multiple pregnancies, far higher than those at home and abroad (2-3%); 25.9% of the subjects had a higher umbilical cord around the neck than the literature (13~25%). (5) the preterm preterm 1min score of 8 to 10 (normal) was 91.7%, far higher than the early (60.6%) and early preterm infants (82.6%), and there was no death in the premature birth group. The per capita hospitalization time and total hospitalization cost in the non preterm birth group increased by 6 obviously. The risk factors of preterm infant asphyxia were the result of multiple factors. From the analysis, the pregnancy weeks, complications, intrauterine distress, birth weight were related risk factors for preterm infant asphyxia. Conclusion: for 6 years, with the increase of time, the pregnancy is guaranteed. The preterm birth rate has a downward trend, with more preterm delivery and higher pregnancy complications and urgent need for prevention and control; some distribution features may be a risk factor for premature birth, including abortion history, age of 18 and 40 years, diabetes, anemia, HBV hepatitis, and premature membrane Pregnancy, cholestasis, placenta previa, sub factors include breech presentation or shoulder presentation, abnormal amniotic fluid, multiple pregnancy, umbilical cord around neck, etc.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R722.6

【共引文献】