预防性McDonald环扎与Shirodkar环扎对早产高危孕妇的临床效果比较  

Comparison of clinical effects of preventive McDonald cerclage and Shirodkar cerclage on pregnant women with high risk of premature delivery

作　　者：章易琳[1] 韩伶俐 倪观太[1] ZHANG Yilin;HAN Lingli;NI Guantai(Department of Obstetrics and Gynecology,Wannan Medical College Yijishan Hospital,Anhui Wuhu 241000,China)

机构地区：[1]皖南医学院弋矶山医院妇产科,安徽芜湖241000

出　　处：《中国妇幼健康研究》2022年第10期108-112,共5页Chinese Journal of Woman and Child Health Research

基　　金：安徽省教育厅高校自然基金重点项目(KJ2018A0267)。

摘　　要：目的探讨预防性McDonald环扎与Shirodkar环扎对早产高危孕妇的临床效果。方法选取2016年1月至2021年11月皖南医学院弋矶山医院收治的127例早产高危孕妇作为研究对象,对其进行宫颈环扎术,根据宫颈位置的高低分为Mc-Donald组(n=27例)与Shirodkar组(n=100例),比较两组孕妇临床指标、并发症、妊娠结局及新生儿预后。结果Shirodkar组手术时间、出血量及住院时间均高于McDonald组,差异有统计学意义(t值分别为31.171、34.509、2.938,P<0.05);Shirodkar组宫内感染率显著高于McDonald组(χ^(2)=3.910,P<0.05),两组胎膜早破、羊水过多、总并发症发生率比较差异无统计学意义(P>0.05);Shirodkar组足月分娩率及分娩孕周均高于McDonald组,早产率及流产率均低于McDonald组,差异有统计学意义(χ^(2)/t值分别为9.033、7.494、4.213、4.213,P<0.05);Shirodkar组新生儿出生体重低于McDonald组(t=2.002,P<0.05),两组新生儿窒息率、新生儿存活率及Apgar评分比较差异无统计意义(P>0.05)。结论选择McDonald手术方法进行宫颈环扎术手术时间短,出血量少,可减少孕妇感染率,而选择Shirodkar手术方法则降低孕妇的早产率与流产率,两种方式均可有效改善母婴结局。Objective To explore the clinical effects of preventive McDonald cerclage and Shirodkar cerclage on pregnant women with high risk of premature delivery.Methods 127pregnant women with high risk of premature delivery admitted to Wannan Medical College Yijishan Hospital from January 2016to November 2021were selected as the research subjects.They underwent cervical cerclage,and were divided into McDonald group(n=27)and Shirodkar group(n=100),according to cervical position.The clinical indicators,complications,pregnancy outcomes and neonatal prognosis were compared between the two groups.Results The surgical time,bleeding volume and hospital stay in Shirodkar group were higher than those in the McDonald group(t=31.171,34.509and 2.938,respectively,P<0.05).The intrauterine infection rate in Shirodkar group was significantly higher than that in McDonald group(χ^(2)=3.910,P<0.05),there were no statistical differences in the incidence rates of premature rupture of membranes and polyhydramnios and total incidence rate of complications between the two groups(P>0.05).The full-term delivery rate and gestational age of delivery in Shirodkar group were higher than those in McDonald group,the premature delivery rate and abortion rate were lower than those in McDonald group(χ^(2)/t=9.033,7.494,4.213and 4.213,respectively,P<0.05).The neonatal birth weight in Shirodkar group was lighter than that in McDonald group(t=2.002,P<0.05),but the differences in neonatal asphyxia rate,neonatal survival rate and Apgar score were not statistically significant between the two groups(P>0.05).Conclusion McDonald surgical method for cervical cerclage has a short surgical time and low amount of bleeding,and it can reduce the infection rate of pregnant women,but Shirodkar surgical method can reduce the premature delivery rate and abortion rate of pregnant women.Both methods can effectively improve the maternal-infant outcomes.

关 键 词：早产高危孕妇 宫颈环扎术 妊娠结局 宫内感染 

分 类 号：R173[医药卫生—妇幼卫生保健]