新的生育政策下高龄产妇早产儿临床特点及围产结局分析  

Analysis of clinical characteristics and perinatal outcome of premature infants of elder parturients under the new birth policy

作　　者：匡德凤[1] 李志国[2] 华绍芳[1] 阙生顺 薛凤霞[4] Kuang Defeng;Li Zhiguo;Hua Shaofang;Que Shengshun;Xue Fengxia(The maternity,The Second Hospital of Tianjin Medical University,Tianjin 300211,P.R.China;Clinical laboratory,The Second Hospital of Tianjin Medical University,Tianjin 300211,P.R.China;Neonatology,The Second Hospital of Tianjin Medical University,Tianjin 300211,P.R.China;Department of Obstetrics and Gynecology,Tianjin Medical University General Hospital,Tianjin 300211,P.R.China)

机构地区：[1]天津医科大学第二医院产科,天津300211 [2]天津医科大学第二医院检验科,天津300211 [3]天津医科大学第二医院新生儿科,天津300211 [4]天津医科大学总医院妇产科,天津300211

出　　处：《中国计划生育和妇产科》2022年第10期49-53,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：天津医科大学第二医院青年基金(项目编号:2019ydey20)。

摘　　要：目的分析新的生育政策下高龄产妇早产儿临床特点及围产结局情况,制定高龄产妇围产期个性化管理方案,改善母儿结局。方法收集天津医科大学第二医院2016年1月至2020年12月早产儿共计1755例的临床资料,其中高龄组早产儿366例(孕母年龄≥35岁),适龄组早产儿1389例(孕母年龄20~35岁)。比较两组的相关临床指标,包括:孕母身高、孕晚期体重、分娩孕周、孕产次、分娩方式、孕期妊娠合并症及并发症;早产儿围生期结局及转入NICU相关指标(住院天数、并发症及血糖、胆红素等各项化验指标)。结果(1)高龄组产妇体质量指数明显高于适龄组[(29.96±4.15)kg/m^(2)vs(28.86±4.29)kg/m^(2)],且高龄产妇一旦发生早产,其孕周更早[(33.87±2.26)周vs(34.24±2.06)周]、孕次[(3.07±1.49)vs(2.0±1.27)]及产次[(0.73±0.58)vs(0.35±0.55)]较适龄组产妇次数更多、新生儿出生评分更低[(7.76±2.16)分vs(8.07±1.66)分](P均<0.001);(2)高龄组中子痫前期(27.32%)、瘢痕子宫(25.95%)、妊娠期糖尿病(13.66%)及胎死宫内发生率(3.00%)明显高于适龄组(19.37%,20.16%,9.43%,1.15%),差异有统计学意义(P<0.05);在妊娠方式及分娩方式方面,高龄组较适龄组辅助生育妊娠(8.74%vs 4.90%)及手术产率(74.04%vs 65.44%)增加,差异均有统计学意义(P<0.05);(3)高龄组早产儿活产率明显低于适龄组(96.99%vs 98.85%),且转入NICU早产儿中高龄组早产儿更易出现贫血(11.01%vs 6.79%)、低血糖(15.29%vs 10.18%)、新生儿呼吸窘迫综合征(respiratory distress syndrome of newborn,NRDS)(19.88%vs 13.35%)、围产窒息(19.27%vs 11.54%)、电解质紊乱(6.73%vs 1.13%)及湿肺(11.31%vs 7.01%)(P均<0.05)。结论(1)新的生育政策下,高龄产妇更易出现危及母儿健康的妊娠期合并症及并发症,导致早产发生;(2)肥胖是高龄产妇早产的原因之一,加强孕期体重管理,对降低不良妊娠结局尤为重要;(3)做好高龄产妇孕前及产前评估(五色法),制定Objective To analyze the clinical characteristics and perinatal outcomes of preterm infants of elderly women under the new fertility policy,and to formulate a personalized perinatal management plan for elderly women to improve the outcomes of mothers and children.Methods The clinical data of 1755 premature infants in The Second Hospital of Tianjin Medical University from January 2016 to December 2020 were collected.Among them,there were 366 premature infants in the elderly age group( gestational age≥35 years old )and 1389 premature infants in the appropriate age group( gestational age between 20 and 35 years old );the related clinical indicators of the two groups were compared,including:maternal height,weight in late pregnancy,gestational age at delivery,parity,delivery mode,pregnancy complications and complications during pregnancy;perinatal outcomes of preterm infants and indicators related to transfer to NICU( days in hospital,complications,blood glucose,bilirubin and other laboratory indicators ).Results( 1 )The maternal BMI in the elderly group was significantly higher than that in the appropriate age group[( 29.96±4.15 )kg/m^( 2 ) vs( 28.86±4.29 )kg/m^( 2 )],and the gestational age of the elderly women was earlier once preterm birth occurred[( 33.87±2.26 )weeks vs( 34.24±2.06 )weeks],pregnancy times[( 3.07±1.49 )vs( 2.03±1.27 )]and parity times[( 0.73±0.58 )vs( 0.35±0.55 )]were more frequent than those in the appropriate age group,and neonatal birth scores were lower[( 7.76±2.16 )points vs( 8.07±1.66 )points( P<0.001 )];( 2 )Preeclampsia( 27.32% ),scar uterus( 25.95% ),gestational diabetes( 13.66% ),and intrauterine stillbirth( 3.00% )in the elderly age group were significantly higher than those in the appropriate age group( 19.37%,20.16%,9.43%,1.15% ),and the difference was statistically significant( P<0.05 );In terms of pregnancy mode and delivery mode,assisted reproductive pregnancy( 8.74%vs 4.90% )and operative birth rate( 74.04%vs 65.44% )increased in the elderly age women compared with tho

关 键 词：高龄 早产 生育政策 

分 类 号：R714.7[医药卫生—妇产科学]