200例无生机的未足月胎膜早破孕妇生殖道病原菌分布和预后  

Distribution and prognosis of genital tract pathogens in 200 pregnant women with previable preterm premature rupture of membranes

作　　者：何佳英[1] 裴金霞[1] HE Jiaying;PEI Jinxia(Department of Gynecology and Obstetrics,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310006,China)

机构地区：[1]杭州市中医院妇产科

出　　处：《中国现代医生》2019年第36期56-59,64,共5页China Modern Doctor

基　　金：浙江省中医药科学研究基金项目（2018ZB086）

摘　　要：目的分析200例无生机的未足月胎膜早破(Previable preterm premature rupture of the membranes,PPROM)孕妇的生殖道感染病原菌的分布及预后。方法选自2003年1月~2017年1月在我院就诊的200例14~23周无生机儿PPROM者,知情选择后强烈要求保胎者,明确诊断入组后予阴道宫颈分泌物解脲及人型支原体,衣原体,淋球菌,加德纳菌,念珠菌,阴道毛滴虫,链球菌等培养。结果200例中95例支原体阳性(其中89例解脲支原体阳性,39例人型支原体阳性,33例两者都阳性),11例在衣原体阳性,7例淋球菌阳性,46例加德纳菌阳性,45例假丝酵母菌阳性,31例B-链球菌阳性,滴虫6例,17例病原菌监测阴性。其中三种以上病原菌感染23例,两种感染56例,一种感染104例,病原菌总感染率高达91.5%,而且病原菌感染种数越多,不良妊娠几率越高且出现越早[1]。积极抗炎对症治疗后其中40例成功保胎至>23周,随访新生儿至一周岁内均无明显不良预后。结论对于未足月胎膜早破,需常规进行阴道病原菌检查,及时明确诊断,积极进行抗感染治疗或预防性抗生素治疗对稳定患者生殖道感染及扩散,改善妊娠预后具有重要意义。Objective To analyze the distribution and prognosis of genital tract pathogens in 200 pregnant women with previable preterm premature rupture of membranes(PPROM).Methods 200 patients with previable PPROM of 14-23 weeks in our hospital from January 2003 to January 2017 were consulted.After informed choice,the patients who strongly asked for preventing miscarriage were given vaginal cervical secretion cultures of ureaplasma and human mycoplasma,chlamydia,neisseria gonorrhoeae,gardnerella,candida,trichomonas vaginalis,streptococcus,etc.Results Of the 200 cases,95 were positive for mycoplasma(89 of them were positive for ureaplasma urealyticum,39 were positive for mycoplasma hominis,33 were positive for both),11 were positive for chlamydia,7 were for neisseria gonorrhoeae,and 46 were for gardnerella,45 cases were positive for candida,31 cases were positive for B-streptococci,6 cases were negative for trichomoniasis,and 17 cases were negative for pathogen detection.Among them,23 cases were infected with more than three pathogens,56 cases were infected with two kinds,and 104 cases were infected with one pathogen.The total infection rate of pathogens was as high as 91.5%.The more the number of pathogen infections was,the higher the probability of adverse pregnancy and the earlier of the occurrence of adverse pregnancy was.After active anti-inflammatory symptomatic treatment,40 of them successfully survived to>23 weeks.There was no significant adverse prognosis in the follow-up of newborns to one year old.Conclusion For patients with premature rupture of fetal membranes,it is necessary to routinely perform vaginal pathogen examination.Timely and clear diagnosis,and active anti-infective treatment or prophylactic antibiotic treatment is of great significance for stabilizing genital tract infection and spread and improving pregnancy prognosis.

关 键 词：无生机的未足月胎膜早破 生殖道感染 病原菌 抗感染 妊娠结局 

分 类 号：R714.433[医药卫生—妇产科学]