未足月胎膜早破孕妇预防使用抗生素的停药指征探讨  

Indications of antibiotic withdrawal in patients with preterm premature rupture of membranes

作　　者：郑明昱 董路 易淑华 严小丽 常青 ZHENG Mingyu;DONG Lu;YI Shuhua;YAN Xiaoli;CHANG Qing(Department of Pharmacy,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Department of Pharmacy,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China;Department of Obstetrics and Gynecology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院药学部,重庆400038 [2]陆军军医大学(第三军医大学)第二附属医院药学部,重庆400037 [3]陆军军医大学(第三军医大学)第一附属医院妇产科,重庆400038

出　　处：《第三军医大学学报》2021年第20期2235-2240,共6页Journal of Third Military Medical University

摘　　要：目的探讨未确诊感染的未足月胎膜早破(preterm premature rupture of membranes,PPROM)孕妇产前抗生素停药指征及其与母婴结局的相关性。方法回顾性分析2015年1月至2019年12月在我院产科住院分娩的PPROM孕24~33^(+6)周期待保胎的孕妇121例,按是否具有感染高危因素及母婴结局将病例分为A组(低危无不良结局组)、B组(低危不良结局组)、C组(高危无不良结局组)和D组(高危不良结局组)。收集临床资料并行单因素分析和多因素Logistic回归分析。结果单因素分析显示:A、B组间,停用抗生素时降钙素原(PCT)、C反应蛋白(CRP)及血红蛋白(Hb)差异有统计学意义(P<0.05)。C、D组间,停用抗生素时疗程、中性粒细胞数/淋巴细胞数比值(NLR)及CRP差异有统计学意义(P<0.05)。多因素分析显示:低危组停用抗生素时CRP升高(5~30 mg/L,>30 mg/L),发生不良母婴结局风险增加(OR=2.227,95%CI:0.689~7.205;OR=14.000,95%CI:1.471~133.233)。高危组停用抗生素时CRP升高(5~30 mg/L,>30 mg/L)或疗程过短(<3 d),发生不良母婴结局风险增加(OR=1.508,95%CI:0.452~5.024;OR=14.278,95%CI:1.526~133.570;OR=4.045,95%CI:1.341~12.199)。结论CRP可用于指导PPROM保胎孕妇的抗生素使用。对于具有感染高风险的PPROM孕妇,抗感染疗程与母婴结局相关,疗程最短不应少于3 d。Objective To explore the indications of prenatal antibiotic withdrawal and its correlation with maternal and infant outcomes of preterm premature rupture of membranes(PPROM)without infection.Methods Clinical data of 121 patients with PPROM between 24 and 33+6 gestational weeks expecting to prolong latency in our hospital between January 2015 and December 2019 were collected and retrospectively analyzed.According to having high risk factors for infection or not and maternal and infant outcomes,they were divided into group A(low-risk but without adverse outcome),group B(low-risk with adverse outcome),group C(high-risk but without adverse outcome)and group D(high-risk with adverse outcome).Univariate analysis and multivariate logistic regression analysis were performed for statistical analysis.Results The results of univariate analysis showed that there were statistical differences in procalcitonin(PCT),C-reactive protein(CRP)and hemeglobin(Hb)between group A and B at discontinuation of antibiotics(P<0.05).Significant differences were seen in duration of antibiotics use,neutrophil-lymphocyte ratio(NLR)and CRP between group C and D at antibiotics discontinuation(P<0.05).Multivariate analysis indicated that when antibiotics were discontinued,the low-risk groups had CRP(5~30 mg/L,>30 mg/L)increased and increased risk of adverse maternal and infant outcomes(OR=2.227,95%CI:0.689~7.205;OR=14.000,95%CI:1.471~133.233);while for the high-risk groups,CRP was elevated(5~30 mg/L,>30 mg/L)or short course of treatment(<3 d),and the incidence of adverse maternal and child outcomes was increased(OR=1.508,95%CI:0.452~5.024;OR=14.278,95%CI:1.526~133.570;OR=4.045,95%CI:1.341~12.199).Conclusion CRP can be used to guide the use of antibiotics in PPROM patients.For those at high risk of infection,the duration of anti-infection therapy is associated with maternal and infant outcomes and should be maintained at least longer than 3 d.

关 键 词：未足月胎膜早破 抗生素 停药 指征 母婴结局 

分 类 号：R714.433[医药卫生—妇产科学] R969.3[医药卫生—临床医学]