北京协和医院25年早产状况的调查  

Preterm Births in Peking Union Medical College Hospital in the Past 25 Years

作　　者：蒋芳[1] 高劲松[1] 钟逸锋[1] 胡静[1] 杨剑秋[1] 马良坤[1] 刘俊涛[1] JIANG Fang GAO Jin-song ZHONG MA Liang-kun Yi-feng HU Jing YANG Jian-qiu LIU Jun-tao(Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《中国医学科学院学报》2016年第5期528-533,共6页Acta Academiae Medicinae Sinicae

基　　金：国家科技支撑计划(2015BAI13B04)~~

摘　　要：目的调查1990年至2014年北京协和医院的早产率、早产孕周分布及病因变化趋势。方法回顾性分析1990年1月1日至2014年12月31日在北京协和医院妇产科分娩的单胎和双胎孕妇,统计其中的早产胎儿数,对不同孕周早产（极早早产、早期早产、轻型早产）和不同病因早产（自发性早产、治疗性早产）的比例及变化趋势进行统计分析。结果 25年间北京协和医院总体早产率为7.8%,呈升高趋势,单胎和双胎的早产率趋势相同。双胎早产儿占早产儿的23.8%,该比例从早期的15.1%增加至目前的28.5%。早产的孕周分布情况是：〈28周的极早早产26例（0.7%）,28~33＋6周的早期早产1199例（33.9%）,34~36＋6周的轻型早产2310例（65.3%）。单胎和双胎早产孕周分布差异无统计学意义（z=0.844,P=0.398）。以5年为时间跨度统计早产孕周的变迁,28周前早产的比例变化不大;28~33＋6周所占比例逐渐增加（从23.8%到36.1%）;34~36＋6周所占比例逐渐减少（从75.5%到63.3%）。单胎和双胎早产儿的孕周分布随时间的变化趋势与总体变化趋势相似。早产临产、早产胎膜早破和治疗性早产分别占早产的20.2%、38.9%和40.9%。自发性早产和治疗性早产的比例在双胎或单胎中差异无统计学意义（χ~2=1.071,P=0.301）。治疗性早产的比例有所增加,常见原因依次为妊娠期高血压疾病、胎儿因素（包括胎儿宫内窘迫、胎儿生长受限）、前置胎盘、妊娠合并心脏病。结论对于综合性医院,早产率有增加的趋势,与多胎妊娠和治疗性早产的数量增加有关。降低多胎妊娠率、有效防治妊娠合并症、并发症是早产干预的重点。Objective To investigate the changes in preterm birth rate,its gestational age distribution,and possible contributors in Peking Union Medical College Hospital（ PUMCH） over the last 25-year period.Methods The clinical data of premature deliveries,both singleton and twins,in PUMCH from January 1,1990 to December 31,2014 were retrospectively analyzed.We counted the number of premature fetuses and assessed the changes of preterm birth rate and its gestational age distribution（ including extremely preterm birth,early preterm birth,and late preterm birth） over time.The etiologies（ including spontaneous and iatrogenic） of preterm birth were also surveyed.Results The overall preterm birth rate was 7.8% in PUMCH,showing a slightly up-trend in both singletons and twins.Twin prematurity accounted for 23.8% of total preterm births,in-creased from 15.1% to 28.5%.Preterm births subgrouped by gestational age included 26 cases（ 0.7%） of extreme prematurity（ 28 weeks）,1199 cases（ 33.9%） of early preterm birth（ 28-33＋ 6weeks）,and 2310 cases（ 65.3%） of late preterm birth（ 34-36＋ 6weeks）.The gestational age distribution in singletons and twins showed no significant difference（ z = 0.844,P = 0.398）.Changes in the proportion of preterm birth before 28 weeks was little,gradually increased in the 28-33＋ 6weeks group（ from 23.8% to 36.1%） and gradually decreased in the 34-36＋ 6weeks group（ from 75.5% to 63.3%）.Trends of gestational age distribution of singleton and twins were similar to that of the total.Spontaneous preterm labor,preterm premature rupture of membrane,and medically indicated（ iatrogenic） preterm birth accounted for 20.2%,38.9%,and 40.9% respectively.There was no difference in singletons and twins（ χ~2= 1.071,P = 0.301）.The proportion of iatrogenic preterm was increased.Common reasons for iatrogenic preterm birth included gestational hypertension,fetal indications（ including fetal distress,fetal growth restriction）,placenta previa,and pregnancy complicate

关 键 词：早产 治疗性早产 早产率 

分 类 号：R714.21[医药卫生—妇产科学]