地塞米松影响双胎妊娠晚期早产儿近远期结局的观察性研究  

Effects of dexamethasone on short-term and long-term outcomes in late preterm infants with twin pregnancy:an observational study

作　　者：张晓丹 魏瑗[1] 吴天晨 赵扬玉[1] 刘晓丹 原鹏波[1] 王颖[1] Zhang Xiaodan;Wei Yuan;Wu Tianchen;Zhao Yangyu;Liu Xiaodan;Yuan Pengbo;Wang Ying(Department of Obstetrics,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]北京大学第三医院产科,北京100191 [2]河北省人民医院产科,石家庄050051

出　　处：《中华妇产科杂志》2024年第9期675-681,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2023YFC2705900);北京市自然科学基金(7244459);北京大学第三医院队列建设项目(BYSYDL2021004)。

摘　　要：目的探讨产前应用地塞米松对双胎妊娠的晚期早产儿近期结局及远期神经系统发育的影响。方法选取2019年1月至2022年12月在北京大学第三医院分娩的双胎妊娠孕妇315例及其630例早产儿(分娩孕周34~36+6周)进行回顾性分析,收集孕妇及早产儿的临床资料,根据是否应用单疗程地塞米松及用药时间,分为未用药组(孕妇93例、早产儿186例)、34周后用药组(孕妇123例、早产儿246例)和34周前用药组(孕妇99例、早产儿198例),分析早产儿近期结局,包括新生儿呼吸窘迫综合征、湿肺、低血糖、新生儿败血症、脑室内出血、支气管肺发育不良以及新生儿坏死性小肠炎的发生率;并分析远期神经系统发育情况,在6~54校正月龄使用"年龄与阶段问卷量表第三版"进行随访,比较早产儿神经系统发育水平。结果(1)一般情况:未用药组孕妇的分娩孕周[36.1周(35.6,36.6周)]晚于34周后用药组[36.1周(35.2,36.4周)]和34周前用药组[35.2周(34.2,36.2周)],分别比较,差异均有统计学意义(P均<0.05)。校正分娩孕周去除胎龄因素后,3组标准化的新生儿出生体重比较,差异无统计学意义(H=3.808,P=0.149)。3组早产儿的性别、小于胎龄儿占比分别比较,差异均无统计学意义(P均>0.05)。(2)近期结局:未用药组、34周后用药组、34周前用药组的湿肺发生率分别为7.0%(13/186)、11.0%(27/246)、16.2%(32/198),3组比较,差异有统计学意义(P=0.018)。3组早产儿新生儿呼吸窘迫综合征、低血糖、败血症、脑室内出血、支气管肺发育不良、新生儿坏死性小肠炎的发生率分别比较,差异均无统计学意义(P均>0.05)。将分娩孕周、新生儿出生体重作为混杂因素,纳入logistic回归分析,结果显示,分娩孕周提前(OR=0.884,95%CI为0.837~0.933,P<0.001)、选择性宫内生长受限Ⅰ型发生率升高(OR=2.967,95%CI为1.153~7.639,P=0.024)均可导致湿肺的发生率升高。(3)远期结局:共有109例孕�ObjectiveTo investigate the effect of prenatal dexamethasone on short-term outcomes and long-term neurological development in late preterm infants with twin pregnancy.MethodsA total of 315 pregnant women with twin pregnancy and their preterm infants who delivered in Peking University Third Hospital from January 2019 to December 2022 were retrospectively analyzed.The clinical data of pregnant women and preterm infants were collected.They were divided into non-medication group(93 pregnant women and 186 preterm infants),medication after 34 weeks group(123 pregnant women and 246 preterm infants),and medication before 34 weeks group(99 pregnant women and 198 preterm infants).Short-term outcomes of preterm infants were analyzed,including the incidence of neonatal respiratory distress syndrome(NRDS),wet lung,hypoglycemia,neonatal septicemia,intraventricular hemorrhage(IVH),bronchopulmonary dysplasia(BPD)and neonatal necrotizing enterocolitis(NEC)."Ages and Stages Questionnaire-Third Edition(ASQ-3)scale"was used to follow up the late neurological development of preterm infants at the corrected age of 6-54 months,and the level of neurological development was compared.Results(1)General conditions:the gestational age at delivery in the non-medication group[36.1 weeks(35.6,36.6 weeks)]was later than that in the medication after 34 weeks group[36.1 weeks(35.2,36.4 weeks)]and medication before 34 weeks group[35.2 weeks(34.2,36.2 weeks)]groups,and the differences were statistically significant(all P<0.05).After correcting for gestational age,there was no significant difference in birth weight among the three groups(H=3.808,P=0.149).There were no significant differences in gender and the proportion of small for gestational age among the three groups(all P>0.05).(2)Short-term outcome:the incidence of wet lung was 7.0%(13/186),11.0%(27/246)and 16.2%(32/198)in the non-medication group,medication after 34 weeks group and medication before 34 weeks group,respectively,and the difference was statistically significant(P=0.018).There wer

关 键 词：妊娠 双胎 地塞米松 婴儿 早产 妊娠末期 神经系统 生长和发育 

分 类 号：R722.6[医药卫生—儿科]