本文選題：新生兒 + 羊水胎糞污染��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]收集我院羊水胎糞污染新生兒的臨床資料,分析不同程度羊水胎糞污染對新生兒不良結(jié)局的影響,為臨床干預(yù)提供依據(jù)。[方法]納入從2015年1月至2016年12月期間,在我院產(chǎn)科出生、發(fā)生羊水胎糞污染的新生兒作為研究對象,收集納入病例中患兒出生前—出生時(shí)—出生后相關(guān)信息。根據(jù)羊水胎糞污染程度將羊水Ⅲ°胎糞污染患兒作為觀察組,羊水Ⅰ°、Ⅱ°胎糞污染患兒作為對照組。運(yùn)用統(tǒng)計(jì)學(xué)X2/t檢驗(yàn)等方法,分析羊水胎糞污染新生兒出現(xiàn)的不良結(jié)局,不同羊水胎糞污染程度、合并圍生期高危因素時(shí)對新生兒不良結(jié)局的影響,以及對羊水Ⅲ°胎糞污染且無活力新生兒的復(fù)蘇情況。[結(jié)果]1.我院2015年1月至2016年12月出生的新生兒羊水胎糞污染發(fā)生1946例,占同期出生活產(chǎn)兒的16%,其中羊水Ⅰ°、Ⅱ°、Ⅲ°胎糞污染分別占24.92%、31.50%、43.58%。過期產(chǎn)兒、足月兒、早產(chǎn)兒分別占10.2%、87.1%、2.7%(≤34周早產(chǎn)兒發(fā)生率為0)。2.羊水胎糞污染與新生兒不良結(jié)局的關(guān)系:①納入病例中,發(fā)生不良結(jié)局319例,發(fā)生率為16.39%。觀察組發(fā)生不良結(jié)局258例,占不良結(jié)局發(fā)生數(shù)的80.88%,對照組發(fā)生不良結(jié)局61例,占不良結(jié)局發(fā)生數(shù)的19.12%,兩組間有統(tǒng)計(jì)學(xué)差異(P0.05)。②新生兒窒息、胎糞吸入綜合征、缺氧缺血性腦病、缺氧缺血性心肌損傷、感染性肺炎、圍生期感染(包括早發(fā)型敗血癥、早期細(xì)菌感染)的患病率分別為2.88%、2.31%、0.15%、2.98%、2.16%、5.91%。觀察組中上述不良結(jié)局患病率均高于對照組中相應(yīng)不良結(jié)局的患病率,兩組間有統(tǒng)計(jì)學(xué)差異(p0.05)。3.羊水胎糞污染與胎心異常、臍動(dòng)脈血?dú)鈖H異常對新生兒結(jié)局的影響:①羊水Ⅰ°、Ⅱ°、Ⅲ°胎糞污染的新生兒合并胎心異常發(fā)生率分別為1.44%、3.10%、12.15%,觀察組和對照組間胎心異常率差異顯著(po.05)。②羊水Ⅰ°、Ⅱ°、Ⅲ°胎糞污染的新生兒臍動(dòng)脈血?dú)鈖H異常發(fā)生率分別為1.44%、3.92%、16.16%,觀察組和對照組間臍動(dòng)脈血?dú)鈖H差異有統(tǒng)計(jì)學(xué)意義(P0.05)。③羊水Ⅲ°胎糞污染出現(xiàn)胎心異常103例,占胎心異常總病例數(shù)的79.84%,羊水Ⅲ。胎糞污染并發(fā)臍動(dòng)脈血?dú)鈖H異常137例,占臍血異�？偛±龜�(shù)的81.55%。④羊水Ⅲ°胎糞污染合并胎心異常時(shí),對預(yù)測窒息、胎糞吸入綜合征、缺氧缺血性腦病、缺氧缺血性心肌損傷、感染性肺炎及圍生期感染的敏感性分別為72.9%、72.2%、0、54.8%、44.4%及20%,特異性分別為 77.7%、73.1%、99.8%、61.8%、43.9%及 65.9%;羊水 Ⅲ°胎糞污染合并臍動(dòng)脈血?dú)鈖H異常時(shí),對上述不良結(jié)局預(yù)測的敏感性分別為74.5%、70.1%、1.0%、61.9%、45.9%及 23.8%,特異性分別為 78.1%、69.6%、99.9%、68.4%、43.9%及65.9%;羊水Ⅲ°胎糞污染合并胎心異常及臍動(dòng)脈血?dú)鈖H異常時(shí),對上述不良結(jié)局預(yù)測的敏感性分別為88.4%、81.4%、0、64.9%、47.3%及35.1%,特異性分別為 89.5%、85.6%、99.9%、85.4%、89.3%及 77.7%。4.對羊水 Ⅲ°胎糞污染且娩出后無活力的新生兒,行氣道胎糞吸引復(fù)蘇后1min、5min的Apgar評分顯著高于未行胎糞吸引的患兒,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),行氣道胎糞吸引復(fù)蘇組患兒MAS發(fā)生率顯著高于未行氣道胎糞吸引復(fù)蘇組患兒,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1.我院羊水胎糞污染的發(fā)生率為16%,其中羊水Ⅰ°、Ⅱ°、Ⅲ°胎糞污染分別占24.92%、31.50%、43.58%。羊水胎糞主要發(fā)生在過期產(chǎn)兒、足月兒及晚期早產(chǎn)兒中,≤34周早產(chǎn)發(fā)生率為0。2.羊水胎糞污染與新生兒窒息、胎糞吸入綜合征、缺氧缺血性腦病、缺氧缺血性心肌損傷、感染性肺炎、圍生期感染相關(guān),其中羊水工Ⅲ°胎糞污染新生兒上述不良結(jié)局發(fā)生率高。3.羊水Ⅲ°胎糞污染新生兒出現(xiàn)胎心異�；蚰氀�?dú)鈖H異常的概率較羊水Ⅰ°、Ⅱ°胎糞污染高,結(jié)合三者情況預(yù)測新生兒窒息、胎糞吸入綜合征及缺氧缺血性心肌損傷發(fā)生的敏感性分別會達(dá)到88.4%、81.4%、64.9%,特異性分別達(dá)到89.5%、85.6%和85.4%。4.羊水Ⅲ°胎糞污染且娩出后無活力新生兒行氣道胎糞吸引可減少窒息發(fā)生,行氣道胎糞吸引對降低MAS發(fā)生率沒有影響。臨床上應(yīng)需嚴(yán)密監(jiān)測羊水性狀,綜合羊水胎糞污染程度、胎心情況、臍動(dòng)脈血?dú)鈖H情況作全面評估,對羊水Ⅲ°胎糞污染進(jìn)行及時(shí)復(fù)蘇和重點(diǎn)監(jiān)測。
[Abstract]:[Objective] to collect the clinical data of neonate with amniotic fluid and meconium pollution in our hospital, and analyze the effect of meconium pollution on amniotic fluid and meconium on the adverse outcome of newborns, and provide the basis for clinical intervention. [Methods] included from January 2015 to December 2016, newborn babies born in obstetrics and gynecology in our hospital were taken as the research object, and the collection was collected. Children with meconium pollution in amniotic fluid were used as observation group, amniotic fluid I degree and second degree meconium contaminated children were used as control group. The adverse outcome of meconium stained amniotic fluid infected newborns and different amniotic fluid fetus were analyzed by X2/t test. The degree of fecal contamination, the effect of the perinatal risk factors on the adverse outcome of the newborn, and the resuscitation of the amniotic fluid III degree meconium contaminated and unanimate newborns. [results]1. 1946 cases of meconium pollution from newborn amniotic fluid born from January 2015 to December 2016 in our hospital accounted for 16% of the birth of the same period of birth, of which amniotic fluid I, II, and III were in the same period. Degree of meconium pollution accounted for 24.92%, 31.50%, 43.58%. overdue, premature infants, premature infants accounted for 10.2%, 87.1%, 2.7% (34 weeks of premature birth rate 0).2. amniotic meconium pollution and neonatal adverse outcomes: (1) included cases, 319 Cases of adverse outcomes, the incidence of adverse outcomes in the 16.39%. observation group 258 cases, accounting for adverse results. 80.88% of the local incidence, 61 cases of adverse outcomes in the control group, 19.12% of the adverse outcomes, and statistically significant differences between the two groups (P0.05). 2. Neonatal asphyxia, meconium aspiration syndrome, hypoxic-ischemic encephalopathy, hypoxic-ischemic myocardial injury, infectious pneumonia, perinatal infection (including early onset sepsis, early bacterial infection) The rate of disease was 2.88%, 2.31%, 0.15%, 2.98%, 2.16%. The prevalence rate of the adverse outcome in the 5.91%. observation group was higher than that in the control group. The two groups had statistical difference (P0.05).3. amniotic fluid meconium pollution and fetal heart abnormality, and the abnormal pH of umbilical artery blood gas on the neonatal outcome: (1) amniotic fluid I, II, and III degree meconium pollution The incidence of abnormal fetal heart rate in the infected newborns was 1.44%, 3.10%, 12.15% respectively. The difference of fetal heart abnormal rate between the observation group and the control group was significant (po.05). The abnormal incidence rate of pH in the umbilical artery blood gas of newborns with amniotic fluid I, II and III degree meconium was 1.44%, 3.92%, 16.16%, respectively, and the difference of pH between the umbilical artery blood gas between the observation group and the control group was statistically significant. (P0.05). (3) 103 cases of fetal heart abnormality in amniotic fluid III degree meconium pollution, 79.84% of the total number of abnormal fetal heart cases, amniotic fluid III, 137 cases of meconium pollution complicated by umbilical artery blood gas pH, 137 cases of abnormal total number of umbilical cord blood, amniotic fluid III degree meconium pollution combined with fetal heart abnormalities, to predict asphyxia, meconium aspiration syndrome, hypoxic-ischemic. The sensitivity of encephalopathy, hypoxic-ischemic myocardial injury, infectious pneumonia and perinatal infection were 72.9%, 72.2%, 0,54.8%, 44.4% and 20% respectively, and the specificity was 77.7%, 73.1%, 99.8%, 61.8%, 43.9% and 65.9%, respectively. The sensitivity of amniotic fluid III degree meconium pollution and umbilical artery blood gas pH abnormality was 74.5%, 70.1%, 1, respectively. The specificity of%, 61.9%, 45.9% and 23.8% were 78.1%, 69.6%, 99.9%, 68.4%, 43.9% and 65.9%, respectively. The sensitivity of the amniotic fluid III degree meconium contamination with abnormal fetal heart and umbilical artery blood gas pH was 88.4%, 81.4%, 0,64.9%, 47.3% and 35.1%, respectively, and the specificity, respectively, and 77.7%.4. to sheep. In the newborns with meconium contamination and childbirth after delivery, the 1min of the airway meconium was attracted to the resuscitation and the Apgar score of 5min was significantly higher than that of the non meconium attraction. The difference was statistically significant (P0.05). The incidence of MAS in the children with the airway meconium attraction resuscitation group was significantly higher than that of the non airway meconium aspiration and resuscitation group. [conclusion P0.05). [conclusion]1. meconium pollution in amniotic fluid in our hospital was 16%, of which amniotic fluid I, II, and meconium pollution accounted for 24.92%, 31.50%, respectively, and 31.50% of meconium, 43.58%. amniotic meconium occurred mainly in expired infants, foot and late premature infants. The incidence of premature birth in less than 34 weeks was 0.2. amniotic fluid meconium pollution and neonatal asphyxia, meconium inhalation synthesis. Hypoxic-ischemic encephalopathy, hypoxic-ischemic encephalopathy, hypoxic-ischemic myocardial injury, infective pneumonia, and perinatal infection, the incidence of the above adverse outcome was high in amniotic fluid workers and meconium contaminated neonates with high.3. amniotic fluid III degree meconium contaminated newborn, the probability of abnormal fetal heart or umbilical blood gas pH was higher than amniotic fluid, high level of meconium pollution, combined with three cases. It was predicted that the sensitivity of neonatal asphyxia, meconium aspiration syndrome and hypoxic-ischemic myocardial injury could reach 88.4%, 81.4%, 64.9%, respectively, and the specificity reached 89.5%, 85.6% and 85.4%.4. amniotic fluid III degree meconium pollution and after delivery, the instiflation of airway meconium could reduce the incidence of asphyxia, and the decrease of airway meconium attraction was reduced. The incidence of MAS was not affected. We should closely monitor the character of amniotic fluid, the degree of meconium pollution in amniotic fluid, the condition of fetal heart, and the pH of umbilical artery blood gas to make a comprehensive assessment. The timely resuscitation and key monitoring of the amniotic fluid III degree meconium pollution are carried out.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R722.1

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