發(fā)布時間：2018-06-26 11:27

  本文選題：絨毛膜羊膜炎 + 臍帶炎��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討絨毛膜羊膜炎及臍帶炎暴露后與34周早產(chǎn)兒肺部損傷及生后常見疾病的相關(guān)性。方法:選取2015.10-2016.8在我院產(chǎn)科分娩并于NICU住院的34周早產(chǎn)兒151例,根據(jù)胎盤病理結(jié)果分為絨毛膜羊膜炎(HCA)陰性、臍帶炎(FV)陰性組,絨毛膜羊膜炎(HCA)陽性、臍帶炎(FV)陰性組,絨毛膜羊膜炎(HCA)陽性、臍帶炎(FV)陽性組,其中絨毛膜羊膜炎陽性者根據(jù)Redline分期、分級標準分為0-3期及0-3級各4組,比較各組呼吸支持時間、呼吸氧和指數(shù)(Pa O2/Fi O2、a/A、A-a DO2)及糾正胎齡達40周時潮氣肺功能各項指標的差異。同時收集孕婦產(chǎn)前相關(guān)資料及患兒入院后相關(guān)資料,比較3組早產(chǎn)兒生后常見疾病發(fā)生率及母親產(chǎn)前及新生兒生后各感染指標差異。結(jié)果:1.呼吸支持時間,各組比較呼吸支持時間均隨著炎癥浸潤程度及炎癥程度的加重逐漸增加。校正胎齡后,無創(chuàng)呼吸支持時間[0.0(0.0-0.0)VS 0.0(0.0-0.0)VS0.0(0.0-58.5)VS 0.0(0.0-130.3)]及有創(chuàng)呼吸支持時間[(0.0(0.0-0.0)VS 0.0(0.0-0.0)VS0.0(0.0-0.0)VS 0.0(0.0-2.3))],各組比較總體差異無統(tǒng)計學(xué)意義(P0.05);總通氣時間[0.0(0.0-0.0)VS 0.0(0.0-5.25)VS 0.0(0.0-64.8)VS 1.0(0.0-114.5)],總吸氧時間[0.0(0.0-8.5)VS 0.0(0.0-57.3)VS 13.5(0.0-131.8)VS 97.0(0.0-284.8)]各組比較差異有統(tǒng)計學(xué)意義(P0.05)。2.呼吸氧和參數(shù)方面,Pa O2[(81.6±17.8)VS(85.7±32.1)VS(92.8±43.8)VS(96.6±37.5)]、Pa O2/Fi O2[385.7(296.3-439.6)VS 376.2(289.6-445.2)VS 373.8(263.6-497.6)VS363.6(233.1-464.3)]、a/A[0.8(0.7-0.9)VS 0.9(0.8-1.1)VS 0.7(0.4-0.9)VS 0.8(0.5-1.0)]、A-a DO2[18.0(6.9-33.6)VS 5.4(-4.8-15.6)VS 30.0(7.7-80.3)VS 28.0(0.5-75.8)]各組比較總體差異無統(tǒng)計學(xué)意義(P0.05),而Fi O2[21.0(21.0-22.0)VS21.0(21.0-23.0)VS 22.0(21.0-30.0)VS 23.0(21.0-30.0)]各組比較總體差異有統(tǒng)計學(xué)意義(P0.05)。3.潮氣肺功能方面,除呼吸頻率外,達峰時間比[(29.79±11.50)VS(27.36±11.01)VS(926.01±13.27)]、達峰容積比[(34.20±8.91)VS(31.90±9.20)VS(31.67±9.55)]、達峰時間[(0.18±0.04)VS(0.18±0.06)VS(0.16±0.07)]、達峰容積[(18.84±22.69)VS(8.17±3.10)VS(6.23±2.73)]等各項潮氣肺功能指標均隨著炎癥進展程度逐漸降低,但各組比較差異均無統(tǒng)計學(xué)意義(P0.05)。4.各疾病發(fā)生率比較:3組比較,各種疾病的發(fā)生率隨炎癥的進展而逐漸增多,且肺炎[7.0(21.2)VS 27.0(44.3)VS 28.0(48.1)]、RDS[0.0(0.0)VS 1.0(1.6)VS 7(12.3)]、顱內(nèi)出血[0.0(0.0)VS 2.0(3.3)VS 7(12.3)]、NEC[0.0(0.0)VS 1.0(1.6)VS8(14.0)]的發(fā)生率HCA+FV+組與HCA-FV-組、HCA+FV-組比較差異有統(tǒng)計學(xué)意義(P0.05)。5.各感染指標比較:產(chǎn)前發(fā)熱[0(0.0)VS 6(9.8)VS 8(57.0)]、產(chǎn)前白細胞數(shù)[(10.6±2.9)VS(12.8±3.8)VS(13.5±3.4)]、C反應(yīng)蛋白(CRP)[(41.5±30.6)VS(79.8±40.3)VS(91.9±42.60]及新生兒降鈣素原(PCT)[(60.1±42.2)VS(75.2±42.1)VS(86.0±44.2)]各組比較差異有統(tǒng)計學(xué)意義(P0.05),且隨著炎癥浸潤程度的加重,感染指標也逐漸增高,而產(chǎn)前N%及患兒血常規(guī)及CRP均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.絨毛膜羊膜炎、臍帶炎暴露后與34周早產(chǎn)兒肺部損傷存在相關(guān)性。2.胎盤炎癥程度越重、進展速度越快,34周早產(chǎn)兒早產(chǎn)兒發(fā)生肺部損傷的風(fēng)險可能越高,需要呼吸支持時間也越長。3.絨毛膜羊膜炎及臍帶炎暴露后對34周早產(chǎn)兒糾正胎齡至40周潮氣肺功能可能沒有影響。4.絨毛膜羊膜炎、臍帶炎暴露后,34周早產(chǎn)兒生后常見疾病發(fā)生率逐漸增加,且與肺炎、RDS、顱內(nèi)出血、NEC的發(fā)生密切相關(guān)。5.母親產(chǎn)前CRP及早產(chǎn)兒生后PCT水平可作為預(yù)測絨毛膜羊膜炎發(fā)生的一項指標。
[Abstract]:Objective: To investigate the correlation between chorionic amnionitis and umbilical cord inflammation after exposure to 34 weeks of premature infants with lung injury and common postnatal diseases. Methods: 151 cases of premature infants were selected 2015.10-2016.8 in obstetric obstetrics and 34 weeks of NICU hospitalization in our hospital. According to the pathological results of the placenta, it was divided into negative amnionitis (HCA), negative group of umbilical cord inflammation (FV), chorionic sheep. Meningitis (HCA) positive, FV negative group, chorioamnionitis (HCA) positive and umbilical inflammation (FV) positive group, among which, chorionic amnionitis positive group were divided into 0-3 stages and 0-3 grade groups according to Redline stage, compared with each group of respiratory support time, respiratory oxygen and index (Pa O2/Fi O2, a/A, A-a DO2) and correction of fetal age at 40 weeks of tidal lung and lung. At the same time, the relative data of pregnant women and related data after admission were collected, and the incidence of common diseases after birth in 3 groups of preterm infants and the difference of infection indexes between prenatal and newborn babies were compared. Results: 1. the time of respiratory support was compared with the degree of inflammation and the degree of inflammation in each group. After the correction of gestational age, no invasive breathing time [0.0 (0.0-0.0) VS 0 (0.0-0.0) VS0.0 (0.0-58.5) VS 0 (0.0-130.3)) and invasive respiratory support time [(0 (0.0-0.0) VS 0 (0.0-0.0) VS0.0 0)] 25) VS 0 (0.0-64.8) VS 1 (0.0-114.5)], total oxygen absorption time [0.0 (0.0-8.5) VS 0 (0.0-57.3) VS 13.5 (0.0-131.8) VS 97 (0.0-284.8)] 5.2) VS 373.8 (263.6-497.6) VS363.6 (233.1-464.3)], a/A[0.8 (0.7-0.9) VS 0.9 (0.8-1.1) VS 0.7 (0.4-0.9) VS 0.8 (0.5-1.0)]. 0 (21.0-30.0) the overall difference was statistically significant (P0.05).3. tidal lung function, except respiratory frequency, peak time ratio [(29.79 + 11.50) VS (27.36 + 11.01) VS (926.01 + 13.27)], peak volume ratio [(34.20 + 8.91) VS (31.90 + 926.01) VS (31.67 + 9.55)], peak time [(0.18 + 926.01) VS], peak volume [18.84 + 22.69) (18.84 + 22.69) VS (8.17 + 3.10) VS (6.23 + 2.73)] were gradually decreasing with the progression of inflammation, but there was no significant difference between each group (P0.05).4., the incidence of various diseases was compared with the 3 groups, and the incidence of various diseases increased with the progression of inflammation, and [7.0 (21.2) VS 27 (44.3) VS 28. (48.1), RDS[0.0 (0) VS 1 (1.6) VS 7 (12.3)], intracranial hemorrhage [0.0 (0) VS 2 (3.3) VS 7 (12.3)], the occurrence rate of NEC[0.0 (0) VS 1 (1.6) VS8), HCA+FV+ group and HCA-FV- group. S (12.8 + 3.8) VS (13.5 + 3.4)], C reactive protein (CRP) [(41.5 + 30.6) VS (79.8 + 40.3) VS) (91.9 + 42.60] and PCT) [(60.1 + 42.2) VS (75.2 + 42.1) VS (60.1 + 42.1) VS (P0.05)] had statistical significance (P0.05), and with the aggravation of inflammatory infiltration, the infection index increased gradually, while prenatal N% and children's blood routine, and CRP no statistical significance (P0.05). Conclusion: 1. chorioamnionitis, after exposure to umbilical cord inflammation and 34 weeks of premature infant lung injury, there is a correlation between.2. placenta inflammation and the higher the speed of the progression, the higher the risk of lung injury in premature infants in 34 weeks, the longer the support time is, the longer the.3. chorioamnionitis and cord inflammation After exposure to 34 weeks of exposure to 34 weeks of premature infants to correct gestational age to 40 weeks, the tidal lung function may not affect the chorioamnionitis. After umbilical cord inflammation, the incidence of common diseases after 34 weeks of premature infants gradually increases, and it is closely related to pneumonia, RDS, intracranial hemorrhage, and NEC, the.5. mother's CRP and the preterm birth PCT level can be used as the predictor of chorionic membrane. An indicator of amnionitis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R722.6

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