新产程标准下第二产程>2 h对孕期抗病毒治疗的慢性乙型肝炎产妇母婴阻断效果及分娩结局的影响  

Influence of the second stage of labor>2 hours of new birth process standards on preventing motherto-child transmission and delivery outcome among chronic hepatitis B puerperas with antiviral therapy

作　　者：吕婧 田瑞华 禹海华 张华 Lyu Jing;Tian Ruihua;Yu Haihua;Zhang Hua(Maternal and Child Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院妇幼中心,100069

出　　处：《中华现代护理杂志》2020年第18期2456-2459,共4页Chinese Journal of Modern Nursing

基　　金：北京市科技计划传染病重大专项“乙型肝炎免疫策略及抗病毒治疗研究”(D161100002716004);“十三五”国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10201201-001-009)。

摘　　要：目的探讨慢性乙型肝炎产妇在新产程标准下第二产程时间>2 h对其母婴阻断效果及分娩结局的影响。方法回顾性分析2014年1月1日—2018年12月1日在北京佑安医院分娩的100例HBV携带产妇的病例资料,将第二产程>2 h的产妇作为观察组,将第二产程<2 h的产妇作为对照组,每组各50例。两组新生儿均随访至7月龄,比较两组的主要观察指标(HBV母婴阻断率)及次要研究指标(手术助产情况、会阴侧切率、产时及产后2 h出血量、新生儿窒息发生率)。结果两组新生儿产时HBsAg阳性例数比较,差异无统计学意义(P>0.05)。两组新生儿7月龄时均无HBsAg阳性检出;观察组的会阴侧切和手术助产数量、产时出血量较对照组均增加,差异有统计学意义(P<0.05)。两组的新生儿窒息发生率与产后2 h出血量比较,差异无统计学意义(P>0.05)。结论新产程标准下第二产程时间>2 h的产妇不会增加乙肝母婴传播率,但是时间>2 h后,更容易增加手术助产和会阴侧切的概率,增加产时出血量。因此对乙肝产妇实行新产程管理时要综合考量,以保障母婴安全。Objective To explore the influence of the second stage of labor>2 hours of new birth process standards on preventing mother-to-child transmission and delivery outcome among chronic hepatitis B puerperas.Methods Clinical data of 100 puerperas with hepatitis B virus(HBV)were retrospectively analyzed in Beijing YouAn Hospital from January 12014 to December 12018.Puerpera with the second stage of labor>2 hours were in observation group,and puerperas with the second stage of labor<2 hours were in control group,50 cases in each group.The follow-up of two groups was carried out until neonate aged 7 months.This study compared the main outcome measures(the rate of mother-to-child transmission of HBV)and the secondary outcome measures(surgical delivery,rate of lateral perineal incision,blood loss during delivery and 2 hours after delivery,incidence of neonatal asphyxia)between two groups.Results There was no statistical difference in the number of neonate with positive HBsAg during delivery between two groups(P>0.05);there was no neonate aged 7 months with positive HBsAg between two groups.Numbers of lateral perineal incision,surgical delivery and blood loss during delivery in observation group increased compared with those in control group with statistical differences(P<0.05).There were no statistical differences in the incidence of neonatal asphyxia and blood loss 2 hours after delivery between two groups(P>0.05).Conclusions The second stage of labor>2 hours of new birth process standards is carried out without increasing the rate of mother-to-child transmission of hepatitis B,but it increases rates of surgical delivery,lateral perineal incision and blood loss during delivery.We should comprehensively consider and discuss when implementing the new birth process management in hepatitis B puerperas so as to assure the safety of months and infants.

关 键 词：肝炎 乙型 慢性 产妇 新产程 第二产程 母婴传播 

分 类 号：R714.251[医药卫生—妇产科学]