2011-2015年长治市某三甲医院胎儿先天畸形现况调查及其影响因素分析

发布时间：2018-05-07 00:15

本文选题：胎儿 + 先天畸形　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:调查2011-2015年长治市某三甲医院胎儿先天畸形(congenital malformation,CM)的患病情况;阐明超声学产前筛查的必要性;对引起胎儿CM的主要危险因素展开分析,从而在孕前的咨询、保健等方面提供可靠依据。方法:对长治市某三甲医院2011-2015年的胎儿CM情况进行登记。2011年~2015年医院终止妊娠产妇(包括正常生产和其他原因的终止妊娠)是9783例,其中胎儿CM是245例。胎儿CM类型按照国际疾病编码(ICD10)进行归类,分析长治市某三甲医院近五年来胎儿CM的现状及特征,以及超声显像技术诊断胎儿CM的基本情况。采用1:2病例对照研究,选取病例组114例,对照组228例,调查产妇的基本信息,包括:孕妇年龄、文化程度、居住地区、孕期是否上感,孕期是否有微生物感染(血清弓形虫、巨细胞病毒、单纯疱疹病毒及风疹病毒感染)、服药史、工作环境、有害物质接触(包括工业毒物、农药、吸烟、饮酒等)、是否服用叶酸、异常生育史、家族史、近亲婚配史,严格筛选胎儿CM的影响因素,通过多因素logistic回归分析来计算这些危险因素的比值比(OR值)。结果:1.长治市某三甲医院2011-2015年胎儿CM现状分析1)终止妊娠的孕妇9783例,胎儿CM 245例,胎儿CM率2.50%;经统计学分析,5年间在此医院胎儿CM的发生率差异比较无统计学意义(X~2=2.116,P=0.191)。2)按照国际疾病分类的系统分类法,胎儿CM排在前五位的依次是中枢神经系统(36.73%)、头面部(18.38%)、心血管系统(16.73%)、骨骼肌肉系统(8.98%)、泌尿生殖系统(6.53%)。按照发生部位分类,胎儿cm排在前5位的分别是是先心病(16.7%)、脊柱裂(12.2%)、脑积水(12.2%)、唇腭裂(11.8%)、无脑畸形(6.5%)。3)男女胎儿cm的发生率分别为2.38%和2.68%;胎儿cm男女性别发生率之比为0.89:1,胎儿cm在性别之间的差异无统计学意义(X~2=0.881,p=0.348);4)城镇和农村胎儿cm的发生率分别为1.62%和3.51%,胎儿cm在城乡间的差异有统计学意义(X~2=55.730,p(27)0.05);5)母亲年龄在25岁、25岁-29岁、30岁-34岁、"g35岁的胎儿cm发生率分别为为2.61%,1.90%,5.43%,7.90%,各年龄组之间胎儿cm发生率差异有统计学意义(X~2=66.033,p(27)0.05)。25-29岁年龄段是胎儿cm的低发年龄,≥35年龄段是胎儿cm高发年龄。6)小学及小学以下产妇所生胎儿cm发生率为5.73%,不同文化程度产妇所生产胎儿cm发生率之间差异有统计学意义(X~2=18.421,p(27)0.05)。7)从确诊时间上来看,在245例胎儿cm儿中,产前确诊167例,占68.16%;产后确诊78例,占31.84%,产前诊断的比例由2011年的52.63%增加至2015年的75.81%。8)从胎儿cm确诊依据上来看,2011年至2015年产前超声检查胎儿cm的检出率为2.10%(194/9219)。在由超声诊断的畸形儿中,在28周前超声检出的畸形儿比例由2011年的35%增加至2015年的63.64%。2.胎儿cm的1:2病例对照研究展开对比分析,得出以下结果:引起胎儿畸形的危险因素主要有:孕期感冒发热(or=2.163,95%ci:1.025-4.563)、病毒感染(0r=3.285,95%ci:1.146-9.411)、孕期服用药物(or=2.603,95%ci:1.061-6.386)、孕期接触有害物质(or=6.264,95%ci:2.211-7.755)、不良孕产史(or=1.97,95%ci:1.058-3.667)、居住农村地区(or=2.526,95%ci:1.498-4.26)、丈夫喝酒(or=2.195,95%ci:1.052-4.582)、吸烟(or=2.017,95%ci:1.067-3.811),而增补叶酸(or=0.324,95%ci:0.136-0.772)为保护性因素。结论:2011-2015年长治市某三甲医院胎儿cm发生率2.50%;按照发生部位胎儿cm前5位的分别是先心病、脊柱裂、脑积水、唇腭裂、无脑畸形。产前超声检查对胎儿畸形检出率为2.10%,在28周前由超声诊断出的胎儿cm占据了越来越高的比例,也就是说,接受产前超声诊断的孕妇越来越多。孕期感冒发热、丈夫喝酒、吸烟等是胎儿CM发生的高危因素。尽快为孕妇补充叶酸,增强孕期保健质量,积极开展产前筛查,通过及早诊断从而尽可能减少CM出生。
[Abstract]:Objective: To investigate the prevalence of congenital malformation (congenital, CM) in a three a hospital in Changzhi, to clarify the necessity of prenatal screening for ultrasound, and to analyze the major risk factors for fetal CM, so as to provide a reliable basis for pre pregnancy counseling and health care. Method: 2011 The status of fetal CM in -2015 years was registered in.2011 ~2015 years (including normal production and other reasons for termination of pregnancy) in 9783 cases, of which the fetal CM was 245. The fetal CM type was classified according to the international disease code (ICD10), and the status and characteristics of fetal CM in a three a hospital of Changzhi in the last five years were analyzed, as well as over the past five years. The basic information of acoustic imaging in the diagnosis of fetal CM was carried out. A case control study of 1:2 was used to select 114 cases of case group and 228 cases in the control group. The basic information of pregnant women was investigated, including the age of the pregnant women, the degree of education, the area of residence, the feeling of pregnancy, and the infection of the pregnant women (serum Toxoplasma, cytomegalovirus, herpes simplex virus and rubella). Drug history, working environment, hazardous material contact (including industrial poison, pesticide, smoking, drinking, etc.), whether to use folic acid, abnormal birth history, family history, marriage history of close relatives, select the factors of fetal CM, and calculate the ratio Ratio of these risk factors through multiple factor Logistic regression analysis (OR value). Results: 1. Changzhi City The analysis of the status of fetal CM in 2011-2015 years of the third one hospital 1) 9783 cases of pregnant women terminating pregnancy, 245 fetal CM, and 2.50% fetal CM rate. By statistical analysis, there was no statistically significant difference in the incidence of fetal CM in this hospital between 5 years (X~2=2.116, P=0.191).2) according to the systematic classification of international disease classification, the first five fetus CM rows were in the middle The armature nervous system (36.73%), the head and face (18.38%), the cardiovascular system (16.73%), the skeletal muscle system (8.98%) and the genitourinary system (6.53%). According to the location of the site, the first 5 of the fetal cm rows are the congenital heart disease (16.7%), the spina bifida (12.2%), the hydrocephalus (12.2%), the cleft lip and palate (11.8%), and the acerebral (6.5%).3) and the incidence of cm in the fetus and the fetus. Do not be 2.38% and 2.68%; the ratio of male and female sex in fetal cm was 0.89:1, and there was no statistically significant difference between the sex of fetal cm (X~2=0.881, p=0.348); 4) the incidence of cm in urban and rural foetus was 1.62% and 3.51% respectively, and the difference between fetal cm in urban and rural areas was statistically significant (X~2=55.730, P (27) 0.05); 5) mothers were 25 years old and 25 years old in 25 years. 30 years old -34 years old, "the incidence of fetal cm at G35 years old is 2.61%, 1.90%, 5.43%, 7.90% respectively, and there is a significant difference in the incidence of fetal cm (X~2=66.033, P (27) 0.05).25-29 age age is the low onset age of fetal cm, and the age of 35 is the high incidence of fetal cm.6) the incidence of cm in primary and primary schools is 5.73. The difference in the incidence of fetal cm produced by pregnant women at different educational levels was statistically significant (X~2=18.421, P (27) 0.05).7) from the time of diagnosis, 167 cases were diagnosed in 245 fetal cm children, 68.16% were prenatal, 78 were diagnosed postpartum, 31.84% were diagnosed, and the proportion of prenatal diagnosis was increased from 52.63% in 2011 to 75.81%.8 in 2015) from fetal cm. From 2011 to 2015, the detection rate of fetal cm was 2.10% (194/9219). In ultrasound diagnosed malformed children, the ratio of abnormal children detected by ultrasound 28 weeks ago from 35% in 2011 to 1:2 case control study of 63.64%.2. fetal cm in 2015 was compared and analyzed, and the following results were obtained: fetal malformation The main risk factors are: pregnancy cold and fever (or=2.163,95%ci:1.025-4.563), virus infection (0r=3.285,95%ci:1.146-9.411), pregnancy drug (or=2.603,95%ci:1.061-6.386), pregnancy exposure to harmful substances (or=6.264,95%ci:2.211-7.755), bad pregnancy history (or=1.97,95%ci:1.058-3.667), living in rural areas (or=2.526,95%ci:1.498-4.2) 6) husband drinking (or=2.195,95%ci:1.052-4.582), smoking (or=2.017,95%ci:1.067-3.811), and supplementation of folic acid (or=0.324,95%ci:0.136-0.772) as a protective factor. Conclusion: the incidence of cm in fetal cm in a three a hospital in Changzhi was 2.50%. The first 5 of the fetus cm were congenital heart disease, spina bifida, hydrocephalus, cleft lip and palate, and no brain. Abnormality. The rate of prenatal ultrasound detection of fetal malformation is 2.10%, and the ratio of fetal cm diagnosed by ultrasound 28 weeks ago is higher and higher, that is to say, more and more pregnant women are diagnosed with prenatal ultrasound. The high risk factors of fetal CM hair are cold and fever during pregnancy, husband drinking, smoking and so on. In order to reduce the CM birth rate, we should carry out prenatal screening actively and diagnose early.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.5;R197.32

【参考文献】