宫内感染与新生儿呼吸窘迫综合征的关系

发布时间：2018-07-04 17:24

本文选题：早产儿 + 宫内感染　；参考：《福建医科大学》2014年硕士论文

【摘要】：背景:随着围产医学技术、辅助生殖技术的发展和人们生活观念的改变，早产儿的发生率显著提高，从而导致新生儿呼吸窘迫综合征（neonatal respiratorydistress syndrome, NRDS）发生率增加。NRDS是早产儿最常见的呼吸系统疾病。近年来，随着产前糖皮质激素应用的推广、生后外源性肺表面活性物质的使用（pulmonary surfactant, PS）和早期辅助通气技术的普及，NRDS患儿的存活率明显提高，然而部分患儿经抢救存活后，仍会遗留慢性肺部疾病、神经系统损伤及视网膜病变等后遗症，严重影响患儿的生活质量。NRDS的发生主要与肺发育不成熟所致的PS缺乏有关，PS的合成受体液pH值、体温、肺血流量和激素等的影响。剖宫产、缺氧、前置胎盘、妊娠期糖尿病和母亲低血压所致的胎儿血容量减少等均可诱发NRDS。早产是PS不足或缺乏的最主要因素，胎龄愈小，发病率愈高。研究表明，感染是引起早产的重要原因，约20%～40%的早产与感染有关，有报道称，发生在24～28周的早产90%以上与感染有关，30周前的早产80%是由于感染所致，由此可见宫内感染和NRDS存在着密切的关系，因此，进一步探讨两者之间的关系，对NRDS的预防与诊治具有重要的学术价值和实际意义。目的:探讨宫内感染与NRDS的关系，，为医务工作人员制定针对NRDS的防治措施提供参考依据，从而降低NRDS的发病率及死亡率，增进新生儿健康。方法：本研究采用回顾性病例对照研究方法，选择2010年6月～2013年9月在我院产科出生并在我院新生儿病房住院的早产儿，根据生后有无发生NRDS，分为NRDS组和非NRDS组。使用统计软件SPSS对11项可疑危险因素进行单因素和多因素非条件logistic回归分析。结果：总共早产儿228例，发生NRDS62例，发病率27.2%。单因素分析显示与NRDS发病有关联的因素有：出生体重、胎龄、Apgar评分、羊水情况、胎膜早破、产前激素、新生儿败血症，而性别、分娩方式、宫内感染、产前抗生素无统计学差异。经多因素logistic回归分析发现：出生体重低（OR=21.724,95%CI:13.541,86.239）、胎龄小（OR=33.709,95%CI:21.584,126.479）、Apgar评分低（OR=18.370,95%CI:7.015,67.403）、羊水Ⅱ度污染（OR=3.250,95%CI:1.118,11.020）/Ⅲ度污染（OR=8.207,95%CI:1.083,17.217）、胎膜早破（OR=2.550,95%CI:3.113,9.294）、新生儿败血症（OR=3.103,95%CI:1.332,7.229）可增加NRDS发病的风险，产前应用激素（OR=0.299,95%CI:0.125,0.717）可预防NRDS的发生。结论:感染相关的因素：羊水污染、胎膜早破、新生儿败血症是NRDS的危险因素。而宫内感染不是NRDS的危险因素。
[Abstract]:Background: with the perinatal medical technology, the development of assisted reproductive technology and the change of people's life concepts, the incidence of premature infants is significantly increased, resulting in the incidence of neonatal respiratory distress syndrome (neonatal respiratorydistress syndrome, NRDS), which is the most common respiratory system disease in premature infants. In recent years, with prenatal sugar The promotion of the use of corticosteroids, the use of exogenous pulmonary surfactant (pulmonary surfactant, PS) and the popularization of early auxiliary ventilation technology, the survival rate of children with NRDS is obviously improved. However, some children still remain the sequelae of chronic lung disease, nervous system injury and retinopathy after survival. The quality of life of children with.NRDS is mainly related to the PS deficiency caused by immature lung development, the pH value of PS receptor fluid, body temperature, pulmonary blood flow and hormone. The caesarean section, anoxia, placenta previa, gestational diabetes and the decrease of fetal blood volume caused by mother hypotension can induce the premature birth of NRDS. is insufficient or lack of PS. The most important factor, the smaller the gestational age, the higher the incidence of the disease. The study shows that infection is an important cause of premature labor, about 20% to 40% of preterm labor is associated with infection. It is reported that more than 90% of preterm birth in 24~28 weeks is associated with infection, and 80% of the preterm birth before 30 weeks is due to infection, and there is a close relationship between intrauterine infection and NRDS, Therefore, to further explore the relationship between them is of great academic value and practical significance for the prevention and treatment of NRDS.
Objective: To explore the relationship between intrauterine infection and NRDS, and to provide reference basis for medical staff to formulate prevention and treatment measures for NRDS, so as to reduce the incidence and mortality of NRDS and improve the health of the newborn.
Methods: in this study, a retrospective case control study was used to select preterm infants born in our hospital from June 2010 to September 2013 and be hospitalized in the neonatal ward of our hospital. According to or without NRDS after birth, NRDS was divided into NRDS and non NRDS groups. The single factor and multi factor unconditional log were used by the statistical software SPSS to carry out the unconditional log of the suspected risk factors. Istic regression analysis.
Results: a total of 228 cases of preterm infants, NRDS62 cases, incidence of 27.2%. single factor analysis showed that the factors associated with the incidence of NRDS were: birth weight, fetal age, Apgar score, amniotic fluid, premature rupture of membranes, prenatal hormones, neonatal septicemia, sex, mode of delivery, intrauterine infection, and antenatal antibiotics were not statistically different. Multifactor logisti C regression analysis showed: low birth weight (OR=21.724,95%CI:13.541,86.239), small fetal age (OR=33.709,95%CI:21.584126.479), low Apgar score (OR=18.370,95%CI:7.015,67.403), amniotic fluid (OR=3.250,95%CI:1.118,11.020) / III degree pollution (OR=8.207,95%CI: 1.083,17.217), premature rupture of membranes (OR=2.550,95%CI:3.113,9.294), neonatal failure Anemia (OR=3.103,95%CI:1.332,7.229) can increase the risk of NRDS, and antenatal hormone (OR=0.299,95%CI:0.125,0.717) can prevent the occurrence of NRDS.
Conclusion: infection related factors: amniotic fluid pollution, premature rupture of membranes and neonatal septicemia are risk factors for NRDS. Intrauterine infection is not a risk factor for NRDS.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.1

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