羊水胎粪污染与围生期新生儿不良结局分析

发布时间：2018-06-14 19:00

本文选题：新生儿 + 羊水胎粪污染　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]收集我院羊水胎粪污染新生儿的临床资料,分析不同程度羊水胎粪污染对新生儿不良结局的影响,为临床干预提供依据。[方法]纳入从2015年1月至2016年12月期间,在我院产科出生、发生羊水胎粪污染的新生儿作为研究对象,收集纳入病例中患儿出生前—出生时—出生后相关信息。根据羊水胎粪污染程度将羊水Ⅲ°胎粪污染患儿作为观察组,羊水Ⅰ°、Ⅱ°胎粪污染患儿作为对照组。运用统计学X2/t检验等方法,分析羊水胎粪污染新生儿出现的不良结局,不同羊水胎粪污染程度、合并围生期高危因素时对新生儿不良结局的影响,以及对羊水Ⅲ°胎粪污染且无活力新生儿的复苏情况。[结果]1.我院2015年1月至2016年12月出生的新生儿羊水胎粪污染发生1946例,占同期出生活产儿的16%,其中羊水Ⅰ°、Ⅱ°、Ⅲ°胎粪污染分别占24.92%、31.50%、43.58%。过期产儿、足月儿、早产儿分别占10.2%、87.1%、2.7%(≤34周早产儿发生率为0)。2.羊水胎粪污染与新生儿不良结局的关系:①纳入病例中,发生不良结局319例,发生率为16.39%。观察组发生不良结局258例,占不良结局发生数的80.88%,对照组发生不良结局61例,占不良结局发生数的19.12%,两组间有统计学差异(P0.05)。②新生儿窒息、胎粪吸入综合征、缺氧缺血性脑病、缺氧缺血性心肌损伤、感染性肺炎、围生期感染(包括早发型败血症、早期细菌感染)的患病率分别为2.88%、2.31%、0.15%、2.98%、2.16%、5.91%。观察组中上述不良结局患病率均高于对照组中相应不良结局的患病率,两组间有统计学差异(p0.05)。3.羊水胎粪污染与胎心异常、脐动脉血气pH异常对新生儿结局的影响:①羊水Ⅰ°、Ⅱ°、Ⅲ°胎粪污染的新生儿合并胎心异常发生率分别为1.44%、3.10%、12.15%,观察组和对照组间胎心异常率差异显著(po.05)。②羊水Ⅰ°、Ⅱ°、Ⅲ°胎粪污染的新生儿脐动脉血气pH异常发生率分别为1.44%、3.92%、16.16%,观察组和对照组间脐动脉血气pH差异有统计学意义(P0.05)。③羊水Ⅲ°胎粪污染出现胎心异常103例,占胎心异常总病例数的79.84%,羊水Ⅲ。胎粪污染并发脐动脉血气pH异常137例,占脐血异常总病例数的81.55%。④羊水Ⅲ°胎粪污染合并胎心异常时,对预测窒息、胎粪吸入综合征、缺氧缺血性脑病、缺氧缺血性心肌损伤、感染性肺炎及围生期感染的敏感性分别为72.9%、72.2%、0、54.8%、44.4%及20%,特异性分别为 77.7%、73.1%、99.8%、61.8%、43.9%及 65.9%;羊水 Ⅲ°胎粪污染合并脐动脉血气pH异常时,对上述不良结局预测的敏感性分别为74.5%、70.1%、1.0%、61.9%、45.9%及 23.8%,特异性分别为 78.1%、69.6%、99.9%、68.4%、43.9%及65.9%;羊水Ⅲ°胎粪污染合并胎心异常及脐动脉血气pH异常时,对上述不良结局预测的敏感性分别为88.4%、81.4%、0、64.9%、47.3%及35.1%,特异性分别为 89.5%、85.6%、99.9%、85.4%、89.3%及 77.7%。4.对羊水 Ⅲ°胎粪污染且娩出后无活力的新生儿,行气道胎粪吸引复苏后1min、5min的Apgar评分显著高于未行胎粪吸引的患儿,差异具有统计学意义(P0.05),行气道胎粪吸引复苏组患儿MAS发生率显著高于未行气道胎粪吸引复苏组患儿,差异具有统计学意义(P0.05)。[结论]1.我院羊水胎粪污染的发生率为16%,其中羊水Ⅰ°、Ⅱ°、Ⅲ°胎粪污染分别占24.92%、31.50%、43.58%。羊水胎粪主要发生在过期产儿、足月儿及晚期早产儿中,≤34周早产发生率为0。2.羊水胎粪污染与新生儿窒息、胎粪吸入综合征、缺氧缺血性脑病、缺氧缺血性心肌损伤、感染性肺炎、围生期感染相关,其中羊水工Ⅲ°胎粪污染新生儿上述不良结局发生率高。3.羊水Ⅲ°胎粪污染新生儿出现胎心异常或脐血血气pH异常的概率较羊水Ⅰ°、Ⅱ°胎粪污染高,结合三者情况预测新生儿窒息、胎粪吸入综合征及缺氧缺血性心肌损伤发生的敏感性分别会达到88.4%、81.4%、64.9%,特异性分别达到89.5%、85.6%和85.4%。4.羊水Ⅲ°胎粪污染且娩出后无活力新生儿行气道胎粪吸引可减少窒息发生,行气道胎粪吸引对降低MAS发生率没有影响。临床上应需严密监测羊水性状,综合羊水胎粪污染程度、胎心情况、脐动脉血气pH情况作全面评估,对羊水Ⅲ°胎粪污染进行及时复苏和重点监测。
[Abstract]:[Objective] to collect the clinical data of neonate with amniotic fluid and meconium pollution in our hospital, and analyze the effect of meconium pollution on amniotic fluid and meconium on the adverse outcome of newborns, and provide the basis for clinical intervention. [Methods] included from January 2015 to December 2016, newborn babies born in obstetrics and gynecology in our hospital were taken as the research object, and the collection was collected. Children with meconium pollution in amniotic fluid were used as observation group, amniotic fluid I degree and second degree meconium contaminated children were used as control group. The adverse outcome of meconium stained amniotic fluid infected newborns and different amniotic fluid fetus were analyzed by X2/t test. The degree of fecal contamination, the effect of the perinatal risk factors on the adverse outcome of the newborn, and the resuscitation of the amniotic fluid III degree meconium contaminated and unanimate newborns. [results]1. 1946 cases of meconium pollution from newborn amniotic fluid born from January 2015 to December 2016 in our hospital accounted for 16% of the birth of the same period of birth, of which amniotic fluid I, II, and III were in the same period. Degree of meconium pollution accounted for 24.92%, 31.50%, 43.58%. overdue, premature infants, premature infants accounted for 10.2%, 87.1%, 2.7% (34 weeks of premature birth rate 0).2. amniotic meconium pollution and neonatal adverse outcomes: (1) included cases, 319 Cases of adverse outcomes, the incidence of adverse outcomes in the 16.39%. observation group 258 cases, accounting for adverse results. 80.88% of the local incidence, 61 cases of adverse outcomes in the control group, 19.12% of the adverse outcomes, and statistically significant differences between the two groups (P0.05). 2. Neonatal asphyxia, meconium aspiration syndrome, hypoxic-ischemic encephalopathy, hypoxic-ischemic myocardial injury, infectious pneumonia, perinatal infection (including early onset sepsis, early bacterial infection) The rate of disease was 2.88%, 2.31%, 0.15%, 2.98%, 2.16%. The prevalence rate of the adverse outcome in the 5.91%. observation group was higher than that in the control group. The two groups had statistical difference (P0.05).3. amniotic fluid meconium pollution and fetal heart abnormality, and the abnormal pH of umbilical artery blood gas on the neonatal outcome: (1) amniotic fluid I, II, and III degree meconium pollution The incidence of abnormal fetal heart rate in the infected newborns was 1.44%, 3.10%, 12.15% respectively. The difference of fetal heart abnormal rate between the observation group and the control group was significant (po.05). The abnormal incidence rate of pH in the umbilical artery blood gas of newborns with amniotic fluid I, II and III degree meconium was 1.44%, 3.92%, 16.16%, respectively, and the difference of pH between the umbilical artery blood gas between the observation group and the control group was statistically significant. (P0.05). (3) 103 cases of fetal heart abnormality in amniotic fluid III degree meconium pollution, 79.84% of the total number of abnormal fetal heart cases, amniotic fluid III, 137 cases of meconium pollution complicated by umbilical artery blood gas pH, 137 cases of abnormal total number of umbilical cord blood, amniotic fluid III degree meconium pollution combined with fetal heart abnormalities, to predict asphyxia, meconium aspiration syndrome, hypoxic-ischemic. The sensitivity of encephalopathy, hypoxic-ischemic myocardial injury, infectious pneumonia and perinatal infection were 72.9%, 72.2%, 0,54.8%, 44.4% and 20% respectively, and the specificity was 77.7%, 73.1%, 99.8%, 61.8%, 43.9% and 65.9%, respectively. The sensitivity of amniotic fluid III degree meconium pollution and umbilical artery blood gas pH abnormality was 74.5%, 70.1%, 1, respectively. The specificity of%, 61.9%, 45.9% and 23.8% were 78.1%, 69.6%, 99.9%, 68.4%, 43.9% and 65.9%, respectively. The sensitivity of the amniotic fluid III degree meconium contamination with abnormal fetal heart and umbilical artery blood gas pH was 88.4%, 81.4%, 0,64.9%, 47.3% and 35.1%, respectively, and the specificity, respectively, and 77.7%.4. to sheep. In the newborns with meconium contamination and childbirth after delivery, the 1min of the airway meconium was attracted to the resuscitation and the Apgar score of 5min was significantly higher than that of the non meconium attraction. The difference was statistically significant (P0.05). The incidence of MAS in the children with the airway meconium attraction resuscitation group was significantly higher than that of the non airway meconium aspiration and resuscitation group. [conclusion P0.05). [conclusion]1. meconium pollution in amniotic fluid in our hospital was 16%, of which amniotic fluid I, II, and meconium pollution accounted for 24.92%, 31.50%, respectively, and 31.50% of meconium, 43.58%. amniotic meconium occurred mainly in expired infants, foot and late premature infants. The incidence of premature birth in less than 34 weeks was 0.2. amniotic fluid meconium pollution and neonatal asphyxia, meconium inhalation synthesis. Hypoxic-ischemic encephalopathy, hypoxic-ischemic encephalopathy, hypoxic-ischemic myocardial injury, infective pneumonia, and perinatal infection, the incidence of the above adverse outcome was high in amniotic fluid workers and meconium contaminated neonates with high.3. amniotic fluid III degree meconium contaminated newborn, the probability of abnormal fetal heart or umbilical blood gas pH was higher than amniotic fluid, high level of meconium pollution, combined with three cases. It was predicted that the sensitivity of neonatal asphyxia, meconium aspiration syndrome and hypoxic-ischemic myocardial injury could reach 88.4%, 81.4%, 64.9%, respectively, and the specificity reached 89.5%, 85.6% and 85.4%.4. amniotic fluid III degree meconium pollution and after delivery, the instiflation of airway meconium could reduce the incidence of asphyxia, and the decrease of airway meconium attraction was reduced. The incidence of MAS was not affected. We should closely monitor the character of amniotic fluid, the degree of meconium pollution in amniotic fluid, the condition of fetal heart, and the pH of umbilical artery blood gas to make a comprehensive assessment. The timely resuscitation and key monitoring of the amniotic fluid III degree meconium pollution are carried out.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

【参考文献】