1105例胎膜早破临床分析

发布时间：2018-02-20 01:56

  本文关键词： 胎膜早破 高危因素 围产结局 剩余羊水量　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨胎膜早破患者高危因素及围产结局;分析早产胎膜早破剩余羊水量与围产结局的关系。方法:(1)2013-01到2016-03于陆军总医院(以下简称我院)住院分娩的6775例孕妇中,选取发生胎膜早破的1105例患者临床资料作为研究对象,依据破膜时的孕周,划为A组(早产胎膜早破组,n=193)和B组(足月胎膜早破组,n=912),采用回顾性研究方法对A、B两组高危因素及围产结局进行整理及统计学分析,采用多因素非条件Logistic回归分析导致早产胎膜早破的独立危险因素;(2)早产胎膜早破组中,除多胎妊娠以及合并其他疾病者21例外,剩余172例,根据早产胎膜早破后剩余羊水指数(amniotic fluid index,AFI)划为C1组(剩余羊水量过少组,AFI"f5cm,n=20)、C2组(偏少组,5cmAFI"f8cm,n=24)及C3组(正常组,8cmAFI25cm,n=128),采用回顾性研究方法比较三组围产结局。结果:1.我院胎膜早破发病率为16.3%,其中早产胎膜早破为2.8%,足月胎膜早破为13.5%。2.我院住院分娩孕妇中,致使胎膜早破的高危因素主要有:流产及引产史、生殖道感染、妊娠合并糖尿病、胎位异常、巨大儿、妊娠期高血压疾病、妊娠合并贫血、多胎妊娠、子宫畸形、羊水过多、前置胎盘、宫颈机能不全等。3.A组与B组相比,生殖道感染的发生率分别是39.9%、18.8%,多胎妊娠的发生率分别是7.3%、0.1%,胎位异常(头盆不称/臀位/横位)的发生率分别是19.2%、10.9%,流产及引产史的发生率分别是48.7%、36.5%,妊娠期高血压疾病的发生率分别是5.7%、1.9%,妊娠合并糖尿病的发生率分别是22.3%、14.3%,前置胎盘的发生率分别是2.1%、0.2%,妊娠合并贫血的发生率分别是5.2%、2.0%,差异均具有统计学意义(p0.05)。4.导致早产胎膜早破的多因素非条件Logistic回归分析结果显示:生殖道感染、多胎妊娠、胎位异常、流产及引产史、前置胎盘以及妊娠合并贫血均是影响早产胎膜早破发生的独立危险因素(OR值分别为3.387,3.533,1.680,1.635,3.020,3.177,95%CI:1.468~13.337,1.892~13.993,1.005~2.807,1.127~2.372,1.841~15.977,1.294~7.798,p0.05)。5.A组与B组相比,剖宫产分娩率分别是56.0%、46.6%,产褥感染的发病率分别是6.2%、3.3%,新生儿肺炎的发病率分别是3.6%、1.4%,新生儿窒息的发病率分别是4.7%、0.8%,差异均具有统计学意义(p0.05)。6.C1组(羊水过少组)平均分娩孕周、新生儿出生体重及男婴分娩率分别是32.56±3.18周,1956.2±703.0g,75.0%;C2组(羊水偏少组)分别为34.15±2.35周,2341.7±585.7g,70.8%;C3组(羊水正常组)分别为34.37±2.19周,3440.5±605.1g,51.6%;三组相比较,羊水越少,新生儿分娩孕周越小、出生体重越低,而男婴分娩率越高,差异均具有统计学意义(P0.05)。7.C1组低出生体重儿、新生儿窒息、新生儿呼吸窘迫综合征、1分钟Apgar评分"f7分,以及产后子宫内膜炎的发病率明显高于另外两组,差异有统计学意义(χ2=6.434,9.238,9.073,9.238,9.073;P0.05),而三组间剖宫产分娩、潜伏时间、胎儿窘迫、绒毛膜羊膜炎、产后出血的发病率比较,差异无统计学意义(P0.05)。结论:(1)我院胎膜早破发病率为16.3%,其中早产胎膜早破为2.8%,足月胎膜早破为13.5%,较文献报道略高。(2)我院胎膜早破最常见的诱因为流产及引产史、生殖道感染等。生殖道感染、多胎妊娠、胎位异常、流产及引产史、前置胎盘、妊娠合并贫血是PPROM发病的独立危险因素。(3)胎膜早破尤其是早产胎膜早破,可导致剖宫产分娩、产褥感染、新生儿肺炎及新生儿窒息的发病率明显增加。(4)早产胎膜早破剩余羊水量过少可引起胎儿分娩孕周提前、新生儿窒息、新生儿呼吸窘迫综合征、产后子宫内膜炎等不良围产结局。
[Abstract]:Objective: To investigate the risk factors of patients with premature rupture of membranes and perinatal outcomes; analysis of the relationship between premature rupture of residual amniotic fluid volume and perinatal outcome. Methods: (1) 2013-01 to 2016-03 in the Army General Hospital (hereinafter referred to our hospital) in 6775 cases of pregnant women hospitalized delivery, choice of the clinical data of 1105 cases of premature rupture of membranes broken as the research object, based on the broken film weeks of gestation, designated as A group (the group of premature rupture of membranes, n=193) and B group (PROM group, n=912), a retrospective study of A, B two groups of risk factors and perinatal outcome analysis and statistics, the multi factor non conditional Logistic regression analysis to independent risk factors for preterm premature rupture of membranes; (2) the group of premature rupture of membranes, in addition to multiple pregnancy and associated with other diseases in 21 cases, the remaining 172 cases, according to the number of residual amniotic fluid after preterm premature rupture of the membranes (amniotic fluid, index, AFI) designated as C 1缁，

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