宫内感染暴露与早产儿肺部损伤及生后常见疾病的相关性研究

发布时间：2018-06-26 11:27

本文选题：绒毛膜羊膜炎 + 脐带炎　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨绒毛膜羊膜炎及脐带炎暴露后与34周早产儿肺部损伤及生后常见疾病的相关性。方法:选取2015.10-2016.8在我院产科分娩并于NICU住院的34周早产儿151例,根据胎盘病理结果分为绒毛膜羊膜炎(HCA)阴性、脐带炎(FV)阴性组,绒毛膜羊膜炎(HCA)阳性、脐带炎(FV)阴性组,绒毛膜羊膜炎(HCA)阳性、脐带炎(FV)阳性组,其中绒毛膜羊膜炎阳性者根据Redline分期、分级标准分为0-3期及0-3级各4组,比较各组呼吸支持时间、呼吸氧和指数(Pa O2/Fi O2、a/A、A-a DO2)及纠正胎龄达40周时潮气肺功能各项指标的差异。同时收集孕妇产前相关资料及患儿入院后相关资料,比较3组早产儿生后常见疾病发生率及母亲产前及新生儿生后各感染指标差异。结果:1.呼吸支持时间,各组比较呼吸支持时间均随着炎症浸润程度及炎症程度的加重逐渐增加。校正胎龄后,无创呼吸支持时间[0.0(0.0-0.0)VS 0.0(0.0-0.0)VS0.0(0.0-58.5)VS 0.0(0.0-130.3)]及有创呼吸支持时间[(0.0(0.0-0.0)VS 0.0(0.0-0.0)VS0.0(0.0-0.0)VS 0.0(0.0-2.3))],各组比较总体差异无统计学意义(P0.05);总通气时间[0.0(0.0-0.0)VS 0.0(0.0-5.25)VS 0.0(0.0-64.8)VS 1.0(0.0-114.5)],总吸氧时间[0.0(0.0-8.5)VS 0.0(0.0-57.3)VS 13.5(0.0-131.8)VS 97.0(0.0-284.8)]各组比较差异有统计学意义(P0.05)。2.呼吸氧和参数方面,Pa O2[(81.6±17.8)VS(85.7±32.1)VS(92.8±43.8)VS(96.6±37.5)]、Pa O2/Fi O2[385.7(296.3-439.6)VS 376.2(289.6-445.2)VS 373.8(263.6-497.6)VS363.6(233.1-464.3)]、a/A[0.8(0.7-0.9)VS 0.9(0.8-1.1)VS 0.7(0.4-0.9)VS 0.8(0.5-1.0)]、A-a DO2[18.0(6.9-33.6)VS 5.4(-4.8-15.6)VS 30.0(7.7-80.3)VS 28.0(0.5-75.8)]各组比较总体差异无统计学意义(P0.05),而Fi O2[21.0(21.0-22.0)VS21.0(21.0-23.0)VS 22.0(21.0-30.0)VS 23.0(21.0-30.0)]各组比较总体差异有统计学意义(P0.05)。3.潮气肺功能方面,除呼吸频率外,达峰时间比[(29.79±11.50)VS(27.36±11.01)VS(926.01±13.27)]、达峰容积比[(34.20±8.91)VS(31.90±9.20)VS(31.67±9.55)]、达峰时间[(0.18±0.04)VS(0.18±0.06)VS(0.16±0.07)]、达峰容积[(18.84±22.69)VS(8.17±3.10)VS(6.23±2.73)]等各项潮气肺功能指标均随着炎症进展程度逐渐降低,但各组比较差异均无统计学意义(P0.05)。4.各疾病发生率比较:3组比较,各种疾病的发生率随炎症的进展而逐渐增多,且肺炎[7.0(21.2)VS 27.0(44.3)VS 28.0(48.1)]、RDS[0.0(0.0)VS 1.0(1.6)VS 7(12.3)]、颅内出血[0.0(0.0)VS 2.0(3.3)VS 7(12.3)]、NEC[0.0(0.0)VS 1.0(1.6)VS8(14.0)]的发生率HCA+FV+组与HCA-FV-组、HCA+FV-组比较差异有统计学意义(P0.05)。5.各感染指标比较:产前发热[0(0.0)VS 6(9.8)VS 8(57.0)]、产前白细胞数[(10.6±2.9)VS(12.8±3.8)VS(13.5±3.4)]、C反应蛋白(CRP)[(41.5±30.6)VS(79.8±40.3)VS(91.9±42.60]及新生儿降钙素原(PCT)[(60.1±42.2)VS(75.2±42.1)VS(86.0±44.2)]各组比较差异有统计学意义(P0.05),且随着炎症浸润程度的加重,感染指标也逐渐增高,而产前N%及患儿血常规及CRP均无统计学意义(P0.05)。结论:1.绒毛膜羊膜炎、脐带炎暴露后与34周早产儿肺部损伤存在相关性。2.胎盘炎症程度越重、进展速度越快,34周早产儿早产儿发生肺部损伤的风险可能越高,需要呼吸支持时间也越长。3.绒毛膜羊膜炎及脐带炎暴露后对34周早产儿纠正胎龄至40周潮气肺功能可能没有影响。4.绒毛膜羊膜炎、脐带炎暴露后,34周早产儿生后常见疾病发生率逐渐增加,且与肺炎、RDS、颅内出血、NEC的发生密切相关。5.母亲产前CRP及早产儿生后PCT水平可作为预测绒毛膜羊膜炎发生的一项指标。
[Abstract]:Objective: To investigate the correlation between chorionic amnionitis and umbilical cord inflammation after exposure to 34 weeks of premature infants with lung injury and common postnatal diseases. Methods: 151 cases of premature infants were selected 2015.10-2016.8 in obstetric obstetrics and 34 weeks of NICU hospitalization in our hospital. According to the pathological results of the placenta, it was divided into negative amnionitis (HCA), negative group of umbilical cord inflammation (FV), chorionic sheep. Meningitis (HCA) positive, FV negative group, chorioamnionitis (HCA) positive and umbilical inflammation (FV) positive group, among which, chorionic amnionitis positive group were divided into 0-3 stages and 0-3 grade groups according to Redline stage, compared with each group of respiratory support time, respiratory oxygen and index (Pa O2/Fi O2, a/A, A-a DO2) and correction of fetal age at 40 weeks of tidal lung and lung. At the same time, the relative data of pregnant women and related data after admission were collected, and the incidence of common diseases after birth in 3 groups of preterm infants and the difference of infection indexes between prenatal and newborn babies were compared. Results: 1. the time of respiratory support was compared with the degree of inflammation and the degree of inflammation in each group. After the correction of gestational age, no invasive breathing time [0.0 (0.0-0.0) VS 0 (0.0-0.0) VS0.0 (0.0-58.5) VS 0 (0.0-130.3)) and invasive respiratory support time [(0 (0.0-0.0) VS 0 (0.0-0.0) VS0.0 0)] 25) VS 0 (0.0-64.8) VS 1 (0.0-114.5)], total oxygen absorption time [0.0 (0.0-8.5) VS 0 (0.0-57.3) VS 13.5 (0.0-131.8) VS 97 (0.0-284.8)] 5.2) VS 373.8 (263.6-497.6) VS363.6 (233.1-464.3)], a/A[0.8 (0.7-0.9) VS 0.9 (0.8-1.1) VS 0.7 (0.4-0.9) VS 0.8 (0.5-1.0)]. 0 (21.0-30.0) the overall difference was statistically significant (P0.05).3. tidal lung function, except respiratory frequency, peak time ratio [(29.79 + 11.50) VS (27.36 + 11.01) VS (926.01 + 13.27)], peak volume ratio [(34.20 + 8.91) VS (31.90 + 926.01) VS (31.67 + 9.55)], peak time [(0.18 + 926.01) VS], peak volume [18.84 + 22.69) (18.84 + 22.69) VS (8.17 + 3.10) VS (6.23 + 2.73)] were gradually decreasing with the progression of inflammation, but there was no significant difference between each group (P0.05).4., the incidence of various diseases was compared with the 3 groups, and the incidence of various diseases increased with the progression of inflammation, and [7.0 (21.2) VS 27 (44.3) VS 28. (48.1), RDS[0.0 (0) VS 1 (1.6) VS 7 (12.3)], intracranial hemorrhage [0.0 (0) VS 2 (3.3) VS 7 (12.3)], the occurrence rate of NEC[0.0 (0) VS 1 (1.6) VS8), HCA+FV+ group and HCA-FV- group. S (12.8 + 3.8) VS (13.5 + 3.4)], C reactive protein (CRP) [(41.5 + 30.6) VS (79.8 + 40.3) VS) (91.9 + 42.60] and PCT) [(60.1 + 42.2) VS (75.2 + 42.1) VS (60.1 + 42.1) VS (P0.05)] had statistical significance (P0.05), and with the aggravation of inflammatory infiltration, the infection index increased gradually, while prenatal N% and children's blood routine, and CRP no statistical significance (P0.05). Conclusion: 1. chorioamnionitis, after exposure to umbilical cord inflammation and 34 weeks of premature infant lung injury, there is a correlation between.2. placenta inflammation and the higher the speed of the progression, the higher the risk of lung injury in premature infants in 34 weeks, the longer the support time is, the longer the.3. chorioamnionitis and cord inflammation After exposure to 34 weeks of exposure to 34 weeks of premature infants to correct gestational age to 40 weeks, the tidal lung function may not affect the chorioamnionitis. After umbilical cord inflammation, the incidence of common diseases after 34 weeks of premature infants gradually increases, and it is closely related to pneumonia, RDS, intracranial hemorrhage, and NEC, the.5. mother's CRP and the preterm birth PCT level can be used as the predictor of chorionic membrane. An indicator of amnionitis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6

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