前置胎盘剖宫产出血并发感染危险因素及胎盘前置对妊娠结局的影响  

Risk factors for complications of infection after cesarean section with placenta previa and the impact of placenta previa on pregnancy outcomes

作　　者：向伟 陈桂红 孙聪欣[1] 王礼贤 赵伟 关晶 XIANG Wei;CHEN Guihong;SUN Congxin;WANG Lixian;ZHAO Wei;GUAN Jing(Shijiazhuang Maternity Hospital,Shijiazhuang 050000,China;The Fourth Hospital of Hebei Medical University)

机构地区：[1]石家庄市妇产医院,河北石家庄050000 [2]河北医科大学第四医院

出　　处：《中国病原生物学杂志》2024年第1期92-95,100,共5页Journal of Pathogen Biology

基　　金：2020年卫生厅课题(No.20201388)。

摘　　要：目的 探析前置胎盘剖宫产出血患者并发感染的危险因素及不同类型胎盘前置状态对妊娠结局的影响。方法 选取本院接诊的316例前置胎盘剖宫产患者为研究对象。患者经超声检查明确胎盘位置,判断胎盘前置类型。采集患者宫颈分泌物,培养后鉴定支原体类型。采集疑似感染产妇的尿液、血液、宫颈分泌物及阴道分泌物等标本进行病原菌培养鉴定。对比患者资料,分析前置胎盘剖宫产孕妇并发出血与宫颈支原体的相关性、并发出血感染的危险因素及不同类型胎盘前置状态对妊娠结局的影响。结果 316例前置胎盘剖宫产患者,93例患者发生出血,出血率29.43%,主要为产后出血。125例患者阴道分泌物检出支原体感染,感染率39.56%,主要为Uu单一感染。出血组支原体感染率49.46%,未出血患者为35.43%,前置胎盘剖宫产出血率与宫颈支原体感染呈正相关。93例出血患者中,33例发生感染,感染率35.48%。共检出病原菌33株,66.67%为革兰阴性菌,主要为铜绿假单胞菌;30.30%为革兰阳性菌,主要为金黄色葡萄球菌;3.03%为真菌(白假丝酵母菌)。单因素分析显示,侵入性操作、贫血、产程、宫缩乏力、留置尿管时间、手术时间、生殖道感染差异有统计学意义(P<0.05)。二元Logistic回归分析显示,侵入性操作、产程≥8 h、手术时间≥90 min、贫血、宫缩乏力、术后留置尿管时间≥24 h,是出血患者并发感染的独立危险因素(P<0.05)。92例为中央型胎盘前置,49例为部分型胎盘前置,175例为边缘型胎盘前置。中央型胎盘前置组的胎盘粘连、胎盘植入、产后出血、子宫切除、早产的发生率分别为54.35%、21.74%、56.52%、17.39%和66.30%,显著高于部分型与边缘型胎盘前置,差异有统计学意义(P<0.05)。结论 前置胎盘剖宫产孕妇易并发产后出血,宫颈分泌物支原体阳性患者的出血率高于阴性患者。中央型胎盘前置孕妇不Objective To explore the risk factors of concurrent infection in patients with placenta previa and cesarean section bleeding,as well as the impact of different types of placenta previa on pregnancy outcomes.Methods The 316 patients with placenta previa undergoing cesarean section admitted to our hospital were selected as the study subjects.The patient underwent ultrasound examination to determine the location of the placenta and determine the type of placenta previa.The cervical secretions were collected from all patients and the type of Mycoplasma identified after cultivation.The samples of urine,blood,cervical secretions,and vaginal secretions were collected from suspected infected puerpera for pathogen cultivation and identification.The clinical data of patients were compared to analyze the correlation between bleeding in pregnant women with placenta previa undergoing cesarean section and cervical Mycoplasma,risk factors for bleeding infection,and the impact of different types of placenta previa on pregnancy outcomes.Results In the 316 patients with placenta previa undergoing cesarean section in this study,93 patients experienced bleeding,with a bleeding rate of 29.43%,mainly postpartum bleeding.Mycoplasma infection was detected in the vaginal secretions of 125 patients,with an infection rate of 39.56%,mainly due to Uu single infection.The infection rate of Mycoplasma in patients with bleeding was 49.46%,while in patients without bleeding,the infection rate of Mycoplasma was 35.43%.The bleeding rate during cesarean section with placenta previa was positively correlated with cervical Mycoplasma infection.Among 93 patients with placenta previa and cesarean section bleeding,33 patients developed infection,with an infection rate of 35.48%.A total of 33 strains of pathogenic bacteria were detected,of which 66.67%were Gram negative bacteria,mainly Pseudomonas aeruginosa,30.30%were Gram positive bacteria,mainly Staphylococcus aureus,3.03%were fungi(Candida albicans).Univariate analysis showed that there were statisti

关 键 词：前置胎盘 危险因素 妊娠结局 

分 类 号：R719.8[医药卫生—妇产科学]