本文選題：早產(chǎn) + 臨床特征��； 參考：《第三軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：研究背景:在產(chǎn)科的并發(fā)癥里,早產(chǎn)是比較常見的,早產(chǎn)兒容易發(fā)生各種近期和遠(yuǎn)期并發(fā)癥,近期如缺氧缺血性腦病、ARDS、各種感染等,遠(yuǎn)期如慢性肺疾病、小兒大腦性癱瘓、失明(主要由于視網(wǎng)膜病變所致)、智力缺陷等等。早產(chǎn)兒在治療和護(hù)理方面的花費(fèi)都比較高,患兒家長乃至整個(gè)家庭都要承受非常大的經(jīng)濟(jì)負(fù)擔(dān),同時(shí)還要遭受精神上的折磨。早產(chǎn)是一個(gè)多因素導(dǎo)致的病癥,病因復(fù)雜,早產(chǎn)的防治一直是產(chǎn)科界的一個(gè)重要課題,。近20年來早產(chǎn)領(lǐng)域的科技進(jìn)步主要體現(xiàn)在早產(chǎn)的預(yù)測(cè)、早產(chǎn)分娩前應(yīng)用腎上腺皮質(zhì)激素促胎肺成熟,減少早產(chǎn)兒的呼吸窘迫綜合癥等疾病的發(fā)生、宮縮抑制劑的治療、孕激素對(duì)早產(chǎn)高危孕婦的預(yù)防作用及兒科早產(chǎn)重癥監(jiān)護(hù)技術(shù)的進(jìn)步等。盡管如此,早產(chǎn)發(fā)生率仍然呈現(xiàn)上升趨勢(shì),并且已經(jīng)成為發(fā)達(dá)社會(huì)的公共衛(wèi)生問題,在中國隨著國民經(jīng)濟(jì)水平和生活水平的提高,早產(chǎn)及早產(chǎn)兒相關(guān)問題越來越凸顯出來并且也越來越受到重視。研究目的:通過對(duì)早產(chǎn)住院分娩病例臨床特征的分析,了解早產(chǎn)的臨床特征及流行病學(xué)特征;探討引起早產(chǎn)的原因及早產(chǎn)兒窒息的相關(guān)高危因素;為開展早產(chǎn)的預(yù)防控制提供科學(xué)依據(jù),以期降低早產(chǎn)的發(fā)生。研究方法:本課題擬收集某三甲醫(yī)院2007年~2012年收治的早產(chǎn)住院分娩病例,通過對(duì)病例的臨床特征分析,了解早產(chǎn)的流行病學(xué)特征,運(yùn)用spss19.0軟件進(jìn)行數(shù)據(jù)整理和?2檢驗(yàn),探討引起早產(chǎn)的原因及早產(chǎn)兒窒息的相關(guān)高危因素;為早產(chǎn)的預(yù)防提供科學(xué)依據(jù),以期降低早產(chǎn)的發(fā)生。結(jié)果:1、數(shù)據(jù)的收集時(shí)間為2007年1月—2012年12月共6年,共納入住院分娩病歷12637例,其中早產(chǎn)患者病例599例。6年期間該院早產(chǎn)率分別為6.2、5.4、5.7、4.6、4.5及3.9%,2007年最高(6.2%),2012年最低(3.9%),隨著時(shí)間的增加,有下降趨勢(shì)。2、晚期早產(chǎn)構(gòu)成比最高(74.5%);其次是中期(14.4%)和早期(10.0%),極早早產(chǎn)最低(1.2%);治療性早產(chǎn)平均比率65.4%,高于非治療組(34.6%)。3、早產(chǎn)病例母體因素分布特征:(1)懷孕次數(shù)≥3次的早產(chǎn)占比46.6%,明顯高于1、2孕次的28.4%和25.0%;(2)早產(chǎn)婦中有流產(chǎn)史的患者約有65%,流產(chǎn)史中采取手術(shù)方式(51.9%)最多;(3)年齡因素:2012年小于18歲和大于40歲組的早產(chǎn)率為12.5%(2/16),與其它年齡組(均值為3.8%)相比較高。(4)早產(chǎn)婦的妊娠合并癥前3位分別為妊娠期糖尿病(15.0%)、貧血(9.7%)、乙型病毒性肝炎(6.0%)。(5)早產(chǎn)婦的妊娠并發(fā)癥前3位分別為胎膜早破(42.4%)、妊娠期肝內(nèi)膽汁淤積癥(ICP)(16.7%)、胎盤前置(9.7%)。4、早產(chǎn)群體的胎兒因素分布特征(1)早產(chǎn)病例里,胎兒肩先露(2.0%)、臀先露(9.0%)的值顯著高于正常新生兒文獻(xiàn)值。(2)有1.3%的羊水過多,5.1%的羊水過少,和文獻(xiàn)報(bào)道水平相比,稍高。(3)早產(chǎn)兒的體質(zhì)量小于2500g者約有43%。(4)有10.0%屬于多胎妊娠,遠(yuǎn)高于國內(nèi)外的報(bào)道水平(2-3%);25.9%的研究對(duì)象發(fā)生臍帶繞頸,與文獻(xiàn)報(bào)道水平(13~25%)相比更高。(5)晚期早產(chǎn)兒阿普加1min評(píng)分8—10分(正常)的構(gòu)成比率91.7%,遠(yuǎn)高于極早(60.6%)和早期早產(chǎn)兒(82.6%)組,且無死亡。5、早產(chǎn)組與非早產(chǎn)組人均住院時(shí)間和住院總費(fèi)用的比較明顯增加6、早產(chǎn)兒窒息的相關(guān)危險(xiǎn)因素早產(chǎn)是多因素共同作用的結(jié)果,從分析中看出孕周、并發(fā)癥、宮內(nèi)窘迫,出生體重為早產(chǎn)兒窒息的相關(guān)危險(xiǎn)因素。結(jié)論:6年來,隨著時(shí)間的增加,受孕期保健措施干預(yù)過的住院分娩者,其早產(chǎn)率有下降趨勢(shì),其中以治療性早產(chǎn)較多,同時(shí)妊娠并發(fā)癥高,迫切需要防控;一些分布特點(diǎn)可能是早產(chǎn)的危險(xiǎn)因素,其中母體因素包括:流產(chǎn)史,18歲和40歲年齡,合并糖尿病、貧血、乙型病毒性肝炎,胎膜早破,妊娠膽淤癥,前置胎盤;子體因素包括:臀先露或肩先露,羊水異常,多胎妊娠,臍帶繞頸等。
[Abstract]:Background: preterm birth is more common in obstetric complications. Premature infants are prone to a variety of short-term and long-term complications, such as hypoxic-ischemic encephalopathy, ARDS, various infections, such as chronic lung disease, cerebral palsy in children, blindness (mainly due to retinopathy), mental defects and so on. Preterm infants are treated and protected. Children's parents and even the whole family have to bear a great economic burden and suffer from mental suffering. Premature birth is a multifactor cause, the cause of which is complicated. The prevention and treatment of premature birth has been an important issue in the obstetrics field. The progress of science and technology in the field of preterm labor in the past 20 years is mainly reflected in the progress of science and technology. Preterm labor predicts the use of corticosteroids to promote fetal lung maturation before delivery, reducing the incidence of premature infants with respiratory distress syndrome, the treatment of uterine contraction inhibitors, the preventive effect of progestin on preterm pregnant women and the progress of the pediatric preterm intensive care technology, although the incidence of premature birth still increases. It has become a public health problem in the developed society. With the improvement of the level of national economy and the improvement of living standards in China, the problems related to preterm and premature birth are becoming more and more prominent and more and more important. A study of the causes of preterm birth and the related risk factors for preterm birth asphyxia; to provide scientific basis for the prevention and control of premature delivery in order to reduce the occurrence of premature birth. Research methods: this subject is to collect cases of premature delivery in a certain hospital in ~2012 in 2007, and to understand the clinical features of the cases and understand the clinical characteristics of the cases. The epidemiological characteristics of preterm birth, using spss19.0 software for data sorting and 2 tests, to explore the causes of preterm birth and related risk factors for premature birth asphyxia; provide a scientific basis for preterm birth prevention in order to reduce the occurrence of preterm labor. Results: 1, the data collection time was from January 2007 to December 2012 for a total of 6 years and included inpatient delivery in hospital. 12637 cases of the case history, of which 599 cases of premature delivery were.6 and 3.9%, the highest (6.2%) in 2007 (6.2%) and the lowest (3.9%) in 2012. With the increase of time, the decline trend was.2, the late preterm birth ratio was the highest (74.5%); the second was the middle (14.4%) and early (10%), the lowest (1.2%); and the treatment early. The average yield ratio was 65.4%, higher than that of non treatment group (34.6%).3, the distribution characteristics of maternal factors in premature cases were: (1) the number of preterm births with more than 3 times of pregnancy accounted for 46.6%, significantly higher than 28.4% and 25% of 1,2 pregnancies; (2) there were about 65% in women with a history of abortion in early parturients and most in abortion history (51.9%); (3) age factors were less than 18 and big in 2012. The preterm birth rate in the 40 year old group was 12.5% (2/16), compared with the other age groups (mean 3.8%). (4) the first 3 prepregnancy complications were gestational diabetes (15%), anemia (9.7%), and viral hepatitis B (6%). (5) 3 of early maternal pregnancy were prematurely premature rupture of membranes (42.4%) and intrahepatic cholestasis of pregnancy (ICP). 16.7%) placenta previa (9.7%).4, the distribution characteristics of fetal factors in preterm population (1) preterm birth cases, fetal shoulder first exposure (2%), gluteus exposure (9%) significantly higher than the normal neonatal literature value. (2) 1.3% amniotic fluid is too much, 5.1% amniotic fluid is too little, slightly higher than the literature level. (3) there is about 43%. (4) in the body mass less than 2500g in preterm infants. 10% were multiple pregnancies, far higher than those at home and abroad (2-3%); 25.9% of the subjects had a higher umbilical cord around the neck than the literature (13~25%). (5) the preterm preterm 1min score of 8 to 10 (normal) was 91.7%, far higher than the early (60.6%) and early preterm infants (82.6%), and there was no death in the premature birth group. The per capita hospitalization time and total hospitalization cost in the non preterm birth group increased by 6 obviously. The risk factors of preterm infant asphyxia were the result of multiple factors. From the analysis, the pregnancy weeks, complications, intrauterine distress, birth weight were related risk factors for preterm infant asphyxia. Conclusion: for 6 years, with the increase of time, the pregnancy is guaranteed. The preterm birth rate has a downward trend, with more preterm delivery and higher pregnancy complications and urgent need for prevention and control; some distribution features may be a risk factor for premature birth, including abortion history, age of 18 and 40 years, diabetes, anemia, HBV hepatitis, and premature membrane Pregnancy, cholestasis, placenta previa, sub factors include breech presentation or shoulder presentation, abnormal amniotic fluid, multiple pregnancy, umbilical cord around neck, etc.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R722.6

【共引文獻(xiàn)】

相關(guān)期刊論文 前3條

1 廖碧,鐘燕桃,張嵐;早產(chǎn)因素分析與防治[J];國際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2005年12期

2 谷秀芹;王明明;廖夢(mèng)蘭;黃麗華;;早產(chǎn)兒母親心理健康狀況分析及護(hù)理對(duì)策[J];國際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2006年12期

3 何繼菲;熊鴻燕;李力;;某醫(yī)院599例早產(chǎn)病例臨床特征分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2014年09期

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本文編號(hào)：1861208