甲硝唑联合维生素C对妊娠期细菌性阴道病疗效分析

发布时间：2018-03-05 07:53

  本文选题：妊娠期　切入点：细菌性阴道病　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:细菌性阴道病(Bacterial vaginosis,BV)系阴道菌群失调的一种疾病。正常阴道内乳酸杆菌为优势菌群,当高浓度的阴道加德纳菌、各种厌氧菌及人型支原体替代其成为主要菌群时即会发病。妊娠期BV的发病率约为10%-50%,且妊娠期BV的检出率远高于阴道滴虫及阴道假丝酵母菌病者,是妊娠期最常见的阴道感染。研究发现BV与胎膜早破(premature rupture of membrane,PROM)、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎、胎儿宫内窘迫、新生儿宫内感染等母儿不良结局相关。传统的治疗妊娠期细菌性阴道病的方法是口服甲硝唑治疗,这种治疗方法有难以避免的副作用,最常见的主诉是口腔内有特殊的金属异味,也有头痛眩晕、恶心呕吐、下腹痛等不适主诉。患者对于孕期口服甲硝唑普遍不能接受,而且口服甲硝唑治疗后会导致继发性阴道假丝酵母病,其发生率是5%到22%。现需要一种安全、有效、依从性高的治疗方法。本研究采用甲硝唑阴道上药联合维生素C(Vitamin C)口服治疗细菌性阴道病,观察其治愈率和母儿结局改变情况。方法:本研究采用回顾性分析方法,查找2013年2月至2016年6月于大连医科大学附属第二医院门诊就诊的妊娠期细菌性阴道病患者共计244例,平均年龄(29±3)岁,治疗起始孕周为24-28周,平均治疗起始孕周(26±2)周;健康孕妇56例(平均年龄28±2岁,自妊娠28周起随访)。将妊娠期细菌性阴道病患者分成三组:A组应用甲硝唑阴道上药联合维生素C口服115例,平均年龄(30±3)岁,平均治疗起始孕周(25±6)周;B组单独应用甲硝唑阴道上药82例,平均年龄(27±3)岁,平均治疗起始孕周为(26±1)周,C组单独应用维生素C口服47例,平均年龄(29±2)岁,平均治疗起始孕周(26±4)周;比较A、B、C三组的治愈率。D组为对照组,健康孕妇56例(平均年龄28±2岁,自妊娠28周起随访)。比较四组患者胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎的发生率,及胎儿窘迫、新生儿感染的发生率,是否具有统计学意义。在300例患者中,按如下条件共选出180例。⑴初产妇;⑵头位;⑶既往体健;⑷无腹部手术史;⑸产检中未发现其他剖宫产指征,符合阴道试产标准。其中A组61例,B组29例,C组42例,D组患者48例。比较四组患者的分娩孕周。所有资料均采用SPSS 20.0统计软件进行数据处理,计数资料采用χ2检验,等级资料用秩和检验,P0.05有统计学意义。结果:1.A组的治愈率为92%,B组的治愈率为41%,C组的治愈率为83%。治疗组A、B、C三组的治愈率有统计学差异,A组的治愈率高于B组,高于C组。2.1 A组在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎的发生率分别为7.83%,0.87%,0.00%,1.74%,0.87%;B组在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎的发生率分别为48.9%,10.64%,4.26%,8.51%,6.38%;C组在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎的发生率分别为17.07%,2.44%,1.22%,2.44%,1.22%;D组在胎膜早破、早产、绒毛膜羊膜炎、羊水腔感染、产后子宫内膜炎的发生率分别为5.36%,0.00%,0.00%,1.79%,0.00%。A组在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局低于B、C组。A组与D组在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局无统计学意义。B与D、C与D在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局有统计学意义2.2 A组在胎儿窘迫、新生儿感染的发生率分别为9.57%,2.61%;B组在胎儿窘迫、新生儿感染的发生率分别为31.91%,17.02%:C组在胎儿窘迫、新生儿感染的发生率分别为25.61%,12.20%;D组在胎儿窘迫、新生儿感染的发生率分别为7.15%,1.19%。A组在胎儿窘迫、新生儿感染的发病率低于B组、C组,与D组无统计学差异。B组与D组,C组与D组在胎儿窘迫、新生儿感染的发病率有统计学差异。3.A组的分娩孕周在大于39周比例为52.46%;B组的分娩孕周在37-38周比例为65.52%;C组的分娩孕周在38-39周比例为59.52%,D组的分娩孕周在大于39周比例为64.58%。四组分娩孕周不同,四组分娩孕周有统计学差异。结论:1.甲硝唑联合维生素C治疗细菌性阴道病的治愈率高于单独应用甲硝唑阴道上药,高于单独口服维生素C。2.甲硝唑联合维生素C治疗细菌性阴道病有效改善胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局,也同时改善胎儿窘迫及新生儿感染等新生儿不良结局,此治疗方法的妊娠不良结局及新生儿不良结局与健康孕妇相似。3.应用甲硝唑联合维生素C治疗细菌性阴道病较单独应用甲硝唑,单独使用维生素C患者孕周延长。
[Abstract]:Objective: bacterial vaginosis (Bacterial vaginosis, BV), the vaginal flora of a disease. The normal vaginal Lactobacillus as the dominant bacteria, when Gardiner vaginal bacteria with high concentration, various anaerobic bacteria and Mycoplasma hominis instead become the main flora is the incidence of pregnancy. The incidence of BV the rate is about 10%-50%, and the BV pregnancy rate is much higher than that of trichomonas and Candida disease, is the most common pregnancy vaginal infection. We found that the BV and premature rupture of membranes (premature rupture of membrane, PROM), preterm birth, chorioamnionitis, postpartum endometritis, amniotic cavity infection, fetal distress, adverse neonatal outcome of intrauterine infection of mother and fetus. The traditional method of treatment of bacterial vaginosis in pregnancy is oral metronidazole treatment, this treatment is difficult to avoid the side effects, the most common complaint is special in the mouth It also has the metallic smell, headache and dizziness, nausea and vomiting, abdominal pain and other discomfort. For patients with pregnancy generally cannot accept oral metronidazole, and oral metronidazole treatment will lead to secondary vaginal Candida disease, its incidence is 5% to 22%. we need a safe and effective treatment method, high compliance. This study used metronidazole vaginal irrigation combined with vitamin C (Vitamin C) oral treatment of bacterial vaginosis, observe the cure rate and perinatal outcomes changes. Methods: This study used a retrospective analysis from February 2013 to June 2016, to find the pregnancy with bacterial vaginosis in the outpatient department of the Second Affiliated Hospital of Dalian Medical University, a total of 244 Cases, the average age (29 + 3) years old, starting treatment of gestational age was 24-28 weeks, the average gestational weeks of treatment initiation (26 + 2) weeks; 56 healthy pregnant women (mean age 28 + 2 years, since the 28 weeks of pregnancy follow-up). 濡婂�犳湡缁嗚弻妫�

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