胎膜早破对胎龄<37周早产儿并发症的影响  

Impact of premature rupture of membranes on neonatal complications in preterm infants with gestational age <37 weeks

作　　者：段顺艳 孔祥永[1,2] 徐凤丹[1] 吕红艳[3] 巨容 李占魁 曾淑娟[6] 武辉[7] 张雪峰[8] 刘卫鹏 刘芳[10] 程红斌[11] 丁艳洁[12] 陈铁强[13] 许平[14] 杨李红[3] 吴素静[3] 汪瑾 彭立 赵小林 丘惠娴[6] 温伟溪 李莹[7] 李楠[7] 文峥[8] 郭果[8] 王凤 李改梅 李薇[10] 赵晓英[10] 许云波[11] 陈文超[11] 尹欢[11] 王晓亮[12] 单瑞艳[12] 韩梅盈 杨春燕[14] 封志纯[1,2] 

机构地区：[1]南方医科大学陆军总医院临床医学院附属八一儿童医院极早产NICU,北京100700 [2]陆军总医院附属八一儿童医院极早产NICU,北京100700 [3]邯郸市妇幼保健院新生儿科,河北邯郸056001 [4]成都市妇女儿童中心医院新生儿科,四川成都610091 [5]陕西省妇幼保健院新生儿科,陕西西安710003 [6]深圳市龙岗中心医院新生儿科,广东深圳518116 [7]吉林大学第一医院新生儿科,吉林长春130021 [8]中国人民解放军第三〇二医院新生儿科,北京100039 [9]海军总医院新生儿科,北京100048 [10]白求恩国际和平医院新生儿科,河北石家庄050082 [11]黄石市妇幼保健院新生儿科,湖北黄石435000 [12]烟台毓璜顶医院新生儿科,山东烟台264000 [13]长沙市妇幼保健院新生儿科,湖南长沙410007 [14]聊城市人民医院新生儿科,山东聊城252000

出　　处：《南方医科大学学报》2016年第7期887-891,共5页Journal of Southern Medical University

摘　　要：目的探讨胎膜早破（premature rupture of the membrane,PROM）对早产儿并发症的影响。方法收取课题组各协作单位产科登记信息在2014年1月1日~2014年12月31日出生的胎龄〈37周的早产儿共7684例。各协作单位派专人培训后填写统一的表格,记录相关信息,包括患儿性别、胎龄、出生体质量、有无PROM、胎盘早剥、产前激素使用、Apgar评分、羊水污染、并发症等。按有无PROM分为PROM组与对照组,统一对其临床资料进行分析。结果（1）PROM组病死率小于对照组,颅内出血、坏死性小肠结肠炎、早产儿视网膜病、支气管肺发育不良发生率均高于对照组,两组间比较差异均有统计学意义（P〈0.05）;OR值95%CI分析：病死率〈1;颅内出血、坏死性小肠结肠炎、早产儿视网膜病、支气管肺发育不良并发症〉1。（2）调整胎龄、出生体质量、性别、分娩方式、胎盘早剥、前置胎盘、产前激素、妊娠期糖尿病、妊娠期高血压病和5 min Apgar评分〈7分等因素后,坏死性小肠结肠炎、早产儿视网膜病、支气管肺发育不良的发生率两组间差异均有统计学意义（P〈0.05）,且OR 95%CI〉1,但病死率和ICH比较,差异均无统计学意义（P〉0.05）。结论 PROM是早产儿并发症坏死性小肠结肠炎、早产儿视网膜病、支气管肺发育不良发生的危险因素,规范处理PROM可减少早产儿并发症NEC、早产儿视网膜病、支气管肺发育不良的发生。Objective To investigate the effect of premature rupture of the membrane （PROM） on neonatal complications in premature infants. Methods The registration information of 7684 preterm infants with gestational age ＆lt;37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without （control）. Results The preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group （P＆lt;0.05）. The 95%confidence interval of the OR value was＆lt;1 for mortality, and was＆gt;1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus （GDM）, gestational period hypertension and 5-min Apgar score ＆lt;7, the incidences of NEC, ROP and BPD were significantly different between the two groups （P＆lt;0.05） with 95%confidence interval of OR value ＆gt;1, but the mortality rate and incidence of ICH were not significantly different between the two groups （P＆gt;0.05）. Conclusion PROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.

关 键 词：胎膜早破 早产儿 病死率 合并症 

分 类 号：R714.433[医药卫生—妇产科学] R722.6[医药卫生—临床医学]