影响晚期先兆流产保胎结局的相关因素分析

发布时间：2018-02-25 22:12

本文关键词： 晚期先兆流产难免流产感染保胎结局　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过对可能影响晚期先兆流产保胎结局的各相关因素分析，以便尽早发现原因，早期干预治疗，，提高保胎成功率，避免难免流产的发生。方法：选自2012年4月-2013年3月在大连市妇产医院因晚期先兆流产住院保胎的患者共227例，其中保胎成功181例，保胎成功率79.7%；难免流产46例，保胎失败率20.3%。所有患者入院时均详细询问病史，并行血常规、CRP（C-反应蛋白）、甲状腺功能、血病毒、超声、阴道分泌物及宫颈分泌物培养，分析可能影响保胎结局的因素。应用SPSS17.0统计软件进行数据的处理，计量资料采用t检验，计数资料采用χ2检验，多因素分析采用非条件Logistic回归分析，预测价值采用诊断试验的ROC分析，P＜0.05具有统计学差异。结果：保胎成功组与难免流产组比较，平均年龄、孕周无统计学差异（P＞0.05），住院时间具有统计学差异（P＜0.05）,保胎成功组住院时间长；两组之间比较，贫血、反复性自然流产（RSA）、感染、宫颈机能不全经宫颈环扎术具有统计学差异（P＜0.05）；多因素非条件Logistic回归分析显示，感染、宫颈机能不全经宫颈环扎术具有统计学差异（P＜0.05），感染是难免流产的独立危险因素OR=5.796，宫颈机能不全经宫颈环扎术是难免流产的独立保护因素OR=0.076；两组之间比较，支原体感染、活动性梅毒具有统计学差异（P＜0.05）；随着血白细胞、中性粒细胞百分比、中性粒细胞绝对值、CRP值的升高，难免流产率上升，保胎成功率下降，两组之间比较具有统计学差异（P＜0.05）；通过ROC曲线分析，血白细胞、中性粒细胞百分比、中性粒细胞绝对值、CRP对预测难免流产具有统计学差异（P＜0.05）。结论：1、影响晚期先兆流产保胎结局的因素有贫血、RSA、感染、宫颈机能不全经宫颈环扎术，其中感染是难免流产的独立危险因素，宫颈机能不全经宫颈环扎术是难免流产的独立保护因素。 2、晚期先兆流产患者感染支原体、活动性梅毒时，难免流产率增加。 3、晚期先兆流产患者血白细胞、中性粒细胞、CRP值越高，保胎成功率越低，难免流产率越高。 4、血白细胞、中性粒细胞、CRP值对患者难免流产具有中等预测价值，这为临床医生是否使用抗生素治疗提供一定的依据，其中CRP对难免流产预测价值最大。
[Abstract]:Objective: to analyze the related factors that may affect the outcome of late threatened abortion, so as to find out the cause as soon as possible, to intervene in early treatment, to improve the success rate of fetal preservation and to avoid the inevitable abortion. Methods: from April 2012 to March 2013, 227 cases were admitted to Dalian Gynecology Hospital for late threatened abortion, including 181 cases of successful fetal preservation, 79.7% success rate of fetal preservation, 46 cases of inevitable abortion. The failure rate of fetal protection was 20.3.All the patients were asked about the history of the disease at admission, followed by blood routine examination of CRPP-C-reactive protein, thyroid function, blood virus, ultrasound, vaginal secretion and cervical secretion culture. The factors that may affect the outcome of fetal preservation were analyzed. The data were processed by SPSS17.0 statistical software. T test was used for measurement data, 蠂 2 test was used for counting data, and non-conditional Logistic regression analysis was used for multivariate analysis. The predictive value was statistically different by ROC analysis of diagnostic test (P < 0. 05). Results: there was no significant difference in average age and gestational age between successful group and inevitable abortion group (P > 0.05), and there was significant difference in hospitalization time (P < 0.05). There was statistical difference in cervical insufficiency by cervical ring ligation (P < 0. 05). Multivariate non conditional Logistic regression analysis showed that infection was found. There was statistical difference in cervical insufficiency through cervical ring ligation (P < 0.05). Infection was an independent risk factor of inevitable abortion, OR5.796. Cervix dysfunctions via cervix cervicalis was the independent protective factor of inevitable miscarriage (OR0.076), and mycoplasma infection was compared between the two groups. The difference of active syphilis was statistically significant (P < 0.05). With the increase of the percentage of white blood cells, neutrophils, absolute values of neutrophil and CRP, the abortion rate increased and the success rate of fetal preservation decreased. By ROC curve analysis, the percentage of white blood cells, neutrophils and neutrophils were significantly different in predicting inevitable abortion (P < 0.05). Conclusion 1. The factors affecting the outcome of late threatened abortion are anemia, RSA, infection and cervical insufficiency through cervix, among which infection is the independent risk factor of inevitable abortion. Cervical insufficiency through cervix is an independent protective factor of inevitable abortion. 2, late threatened abortion patients infected with mycoplasma, active syphilis, inevitable abortion rate increased. 3. The higher the level of leukocyte and neutrophil CRP in patients with late threatened abortion, the lower the success rate of fetal preservation and the higher the rate of inevitable abortion. 4. The values of leukocyte and neutrophil CRP have moderate predictive value for inevitable abortion, which provides a certain basis for clinicians to use antibiotic therapy, among which CRP is the most valuable predictor of inevitable abortion.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

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