384例宫内感染的病因分析  

Pathogenetic analysis of intrauterine infection（IAI） in 384 casest

作　　者：胡冰梅[1] 李丽容[1] 方芙蓉[1] 

机构地区：[1]惠州市中心人民医院,广东惠州516001

出　　处：《现代保健（医学创新研究）》2008年第14期19-20,共2页

摘　　要：目的 通过回顾性分析，对确认IAI的病因、预后、检测手段和治疗方法等方面进行探讨。方法 2007年1月1日-2007年12月30日临床诊断IAI385例，确诊384例，从母亲发热，体温≥37．5℃，产妇心率〉100次／min，胎心率〉160次／min，羊水臭味，子宫压痛，末梢血WBC〉15×10^9／L，C反应蛋白（CRY）〉8mg／L。满足以上条件3个及以上为临床标准。如胎盘病理结果有急性炎细胞浸润和（或）母体宫腔培养、新生儿咽拭子或耳拭子细菌培养阳性为临床确诊标准。结果 IAI临床表现母血白细胞、C-反应蛋白及体温升高多见，孕妇心动过速和胎心率加快相对较少，而子宫压痛和羊水则更少见，子宫压痛仅出现于2例感染严重病例。IAI患者中，胎膜早破在早产组明显多于足月产组（P〈0．001）。384例IAI发生羊水粪染138例，占35．59％。384例IAI中宫腔病原体培养阳性142例，占36．98％，其中胎膜早破组和非胎膜早破组例数分别为49例、55例，分别占34．5％、38．73％。病原体培养阳性结果在两组间亦无差异（P〉0．05）。在384例IAI中发生产褥感染23例，发生率6．00％，其中2例严重感染发生产后子宫内膜炎。结论 宫内感染与胎膜早破尤其是PROM、阴道检查次数、羊水粪染可能相关，可引起产程异常、新生儿感染等，在围生保健和分娩过程中应加强管理，积极预防和治疗宫内感染以改善母儿预后。Objective To approach etiopathogenisis confirmation, prognosis, detection method and treatment of IAI. Methods From Jan 1 date 2007 to Dec 30 date 2007, clinical diagnosis was 385 cases, final diagnosis was 384 cases. Mother was fever, BT≥37.5℃ , puerperant HR 〉 100/min, FHR 〉 160/min, amniotic fluid was foul smell, womb was tenderness, peripheral blood WBC 〉 15×10^9/L, CRY 〉 8 mg/L. Satisfied more than three symptom above as clinical standard. Placenta patho - result was acute inflammation cell infiltration and （or） cultivation in parent womb, neonate throat swab or ear swab bacterial culture was positive as clinical definite standard. Results Maternal blood white cell, C -reactive protein and fervesccnce was more in clinical situation, puerperant tachycardia and fast fetal heart rate was relative less, womb ten- derness and amniotie fluid smelly was much less in clinical situation. Only 2 serious infection cases had womb tenderness. In IAI patients, premature rupture of membrane in premature birth group was obviously more than in term birth group （P 〈0. 001 ）. Amniotic fluid dung were 138 cases, hold 35.59%. Pathogen in womb cultivation appeared positive were 142 cases, hold 36.98%. Premature rupture of membrane group and non premature rupture of membrane group were 49 cases and 55 cases, difference hold 34.5% and 38.73%. Pathogen cultivation positive result in the two groups was undifference （ P 〉 0. 05 ）. Puerperal infection were 23 cases, incidence rate was 6.00%, and 2 cases were serious infected, became to puerperal endometritis. Conclusion Intrauterine infection may relative with premature rupture of membrane, times of vaginal examination and amniotic fluid dung. It causes birth process abnormal, infection of newborn. Perinatal health care and childbirth process should be strengthening of management, positively prevent and treat intrauterine infection to improve prognosis.

关 键 词：宫内感染 病因 

分 类 号：R714.259[医药卫生—妇产科学]