胎儿生长受限213例临床分析

发布时间：2018-02-21 09:57

  本文关键词： 胎儿生长受限 危险因素 围产儿结局 早发型 晚发型　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨胎儿生长受限(FGR)发病的危险因素及对围产儿结局的影响,为临床上正确干预,降低胎儿生长受限发病率,提高婴儿健康水平提供一定的理论基础。方法回顾性分析2011年07月至2016年03月在陆军总医院妇产科收治的FGR,将符合入选标准的213例母儿患者作为FGR组,同期(在入选FGR组的上一例或下一例)住院分娩(包括引产)的健康母儿患者为对照组。采集基本信息包括孕产妇姓名,年龄,孕产史,分娩孕周。本次孕期情况:妊娠期并发症、分娩时间、分娩方式、新生儿出生体重、新生儿结局等临床资料,分析FGR发病的危险因素、及不同发病孕周、分娩时间、分娩方式对围产儿结局的影响。结果1.我院FGR的发病率为1.92%,低于我国所报道的发病率(6.39%);经产前超声诊断171例,分娩后诊断42例,产前诊断率为80.28%。2.FGR组与对照组的年龄、孕次、产次、分娩孕周的比较,差异均无统计学意义(P0.05)。两组FGR危险因素的比较,FGR组的妊娠期高血压疾病、羊水异常、脐血流异常的发生率明显高于对照组,差异显著有统计学意义(P0.05)。有妊娠期高血压疾病的孕产妇患FGR危险性是无妊娠期高血压疾病的2.523倍,有羊水异常的发病是羊水正常的2.496倍,有脐血流异常的发病风险增加了4.297倍。3.将发生FGR的213例患者分为早发型组(发病孕周为≤32周),晚发型组(发病孕周为32周),早发型组主要危险因素为妊娠期高血压疾病、脐血流异常,晚发型组主要因素为羊水异常;妊娠期高血压疾病、脐血流异常在早发型组明显高于晚发型组,差异有统计学意义(P0.05)。晚发型组的1min Apgar评分、5min Apgar评分、10min Apgar评分、新生儿体重均较早发型组高,差异均有统计学意义(P0.05),而转儿科率及围产儿死亡率均以早发型组发生率较高,但仅后者比较差异有统计学意义(P0.05)。4.按分娩孕周不同将FGR组分为三组:第1组为≤33+6周,第2组为34-36+6周,第3组为37-42周,各组的新生儿体重(分别为1455.8±369.2 g、2053.3±325.5 g、2611.3±393.5 g),以第3组最高,差异显著有统计学意义(P0.05),新生儿窒息(各组发生率分别为12.5%、6.45%、1.35%),转儿科率(各组发生率分别为75%、70.97%、24.32%),围产儿死亡(各组发生率分别为15.79%、8.82%、0.67%),比较各组发生率均可见显著差异(p0.001)。5.FGR组中有较高的剖宫产率(69.48%),急诊剖宫产有79例,择期剖宫产有69例,对手术指征进行统计,产时胎儿窘迫居于急诊剖宫产原因的首位(40.5%)。结论1.我院于2011年07月至2016年03月期间FGR的发病率为1.92%,产前诊断率为80.28%。2.妊娠期高血压疾病、脐血流异常、羊水异常是FGR发病的危险因素。3.早发型FGR具有高合并症的特点,新生儿结局较差,要合理管理早发型FGR、旨在改善新生儿预后。4.胎龄是影响FGR围产儿结局的关键因素,母婴情况允许的条件下,可适当延长孕周,根据个体化原则,适时、适宜方式终止妊娠,有利于提高患儿生存质量。
[Abstract]:Objective to explore the risk factors of FGRand its influence on perinatal outcome in order to correct clinical intervention and reduce the incidence of fetal growth restriction. Methods from July 2011 to March 2016, two hundred and thirteen mothers and infants who were admitted to the General Army Hospital in the Department of Gynecology and Obstetrics and Obstetrics and Gynecology and Obstetrics and Gynecology, were selected as FGR group. During the same period (one or the next in the FGR group), healthy mothers and infants who were hospitalized to give birth (including induced labor) served as the control group. Basic information was collected, including the name, age, history of pregnancy and childbirth. Pregnancy: complications of pregnancy, delivery time, delivery mode, birth weight of newborn, neonatal outcome and other clinical data, analysis of the risk factors of FGR, as well as different gestational weeks, delivery time, Results 1. The incidence of FGR in our hospital was 1.92 2, which was lower than 6.39% reported in our country, 171 cases were diagnosed by prenatal ultrasound, 42 cases were diagnosed after delivery, the rate of prenatal diagnosis was 80.28.2.The age and pregnancy of FGR group and control group were 80.28. 2. There was no significant difference in the risk factors of FGR between the two groups. The incidence of abnormal amniotic fluid and umbilical blood flow in the FGR group was significantly higher than that in the control group. The risk of FGR in pregnant women with hypertensive disorder complicating pregnancy was 2.523 times higher than that without gestational hypertension, and the incidence of amniotic fluid abnormality was 2.496 times higher than that of normal amniotic fluid. The risk of abnormal umbilical blood flow was increased by 4.297-fold. 3. The patients with FGR were divided into early onset group (gestational age 鈮，

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