本文選題：早產(chǎn)兒 + 宮內感染��； 參考：《福建醫(yī)科大學》2014年碩士論文

【摘要】：背景:隨著圍產(chǎn)醫(yī)學技術、輔助生殖技術的發(fā)展和人們生活觀念的改變，早產(chǎn)兒的發(fā)生率顯著提高，從而導致新生兒呼吸窘迫綜合征（neonatal respiratorydistress syndrome, NRDS）發(fā)生率增加。NRDS是早產(chǎn)兒最常見的呼吸系統(tǒng)疾病。近年來，隨著產(chǎn)前糖皮質激素應用的推廣、生后外源性肺表面活性物質的使用（pulmonary surfactant, PS）和早期輔助通氣技術的普及，NRDS患兒的存活率明顯提高，然而部分患兒經(jīng)搶救存活后，仍會遺留慢性肺部疾病、神經(jīng)系統(tǒng)損傷及視網(wǎng)膜病變等后遺癥，嚴重影響患兒的生活質量。NRDS的發(fā)生主要與肺發(fā)育不成熟所致的PS缺乏有關，PS的合成受體液pH值、體溫、肺血流量和激素等的影響。剖宮產(chǎn)、缺氧、前置胎盤、妊娠期糖尿病和母親低血壓所致的胎兒血容量減少等均可誘發(fā)NRDS。早產(chǎn)是PS不足或缺乏的最主要因素，胎齡愈小，發(fā)病率愈高。研究表明，感染是引起早產(chǎn)的重要原因，約20%～40%的早產(chǎn)與感染有關，有報道稱，發(fā)生在24～28周的早產(chǎn)90%以上與感染有關，30周前的早產(chǎn)80%是由于感染所致，由此可見宮內感染和NRDS存在著密切的關系，因此，進一步探討兩者之間的關系，對NRDS的預防與診治具有重要的學術價值和實際意義。 目的:探討宮內感染與NRDS的關系，，為醫(yī)務工作人員制定針對NRDS的防治措施提供參考依據(jù)，從而降低NRDS的發(fā)病率及死亡率，增進新生兒健康。 方法：本研究采用回顧性病例對照研究方法，選擇2010年6月～2013年9月在我院產(chǎn)科出生并在我院新生兒病房住院的早產(chǎn)兒，根據(jù)生后有無發(fā)生NRDS，分為NRDS組和非NRDS組。使用統(tǒng)計軟件SPSS對11項可疑危險因素進行單因素和多因素非條件logistic回歸分析。 結果：總共早產(chǎn)兒228例，發(fā)生NRDS62例，發(fā)病率27.2%。單因素分析顯示與NRDS發(fā)病有關聯(lián)的因素有：出生體重、胎齡、Apgar評分、羊水情況、胎膜早破、產(chǎn)前激素、新生兒敗血癥，而性別、分娩方式、宮內感染、產(chǎn)前抗生素無統(tǒng)計學差異。經(jīng)多因素logistic回歸分析發(fā)現(xiàn)：出生體重低（OR=21.724,95%CI:13.541,86.239）、胎齡小（OR=33.709,95%CI:21.584,126.479）、Apgar評分低（OR=18.370,95%CI:7.015,67.403）、羊水Ⅱ度污染（OR=3.250,95%CI:1.118,11.020）/Ⅲ度污染（OR=8.207,95%CI:1.083,17.217）、胎膜早破（OR=2.550,95%CI:3.113,9.294）、新生兒敗血癥（OR=3.103,95%CI:1.332,7.229）可增加NRDS發(fā)病的風險，產(chǎn)前應用激素（OR=0.299,95%CI:0.125,0.717）可預防NRDS的發(fā)生。 結論:感染相關的因素：羊水污染、胎膜早破、新生兒敗血癥是NRDS的危險因素。而宮內感染不是NRDS的危險因素。
[Abstract]:Background: with the perinatal medical technology, the development of assisted reproductive technology and the change of people's life concepts, the incidence of premature infants is significantly increased, resulting in the incidence of neonatal respiratory distress syndrome (neonatal respiratorydistress syndrome, NRDS), which is the most common respiratory system disease in premature infants. In recent years, with prenatal sugar The promotion of the use of corticosteroids, the use of exogenous pulmonary surfactant (pulmonary surfactant, PS) and the popularization of early auxiliary ventilation technology, the survival rate of children with NRDS is obviously improved. However, some children still remain the sequelae of chronic lung disease, nervous system injury and retinopathy after survival. The quality of life of children with.NRDS is mainly related to the PS deficiency caused by immature lung development, the pH value of PS receptor fluid, body temperature, pulmonary blood flow and hormone. The caesarean section, anoxia, placenta previa, gestational diabetes and the decrease of fetal blood volume caused by mother hypotension can induce the premature birth of NRDS. is insufficient or lack of PS. The most important factor, the smaller the gestational age, the higher the incidence of the disease. The study shows that infection is an important cause of premature labor, about 20% to 40% of preterm labor is associated with infection. It is reported that more than 90% of preterm birth in 24~28 weeks is associated with infection, and 80% of the preterm birth before 30 weeks is due to infection, and there is a close relationship between intrauterine infection and NRDS, Therefore, to further explore the relationship between them is of great academic value and practical significance for the prevention and treatment of NRDS.
Objective: To explore the relationship between intrauterine infection and NRDS, and to provide reference basis for medical staff to formulate prevention and treatment measures for NRDS, so as to reduce the incidence and mortality of NRDS and improve the health of the newborn.
Methods: in this study, a retrospective case control study was used to select preterm infants born in our hospital from June 2010 to September 2013 and be hospitalized in the neonatal ward of our hospital. According to or without NRDS after birth, NRDS was divided into NRDS and non NRDS groups. The single factor and multi factor unconditional log were used by the statistical software SPSS to carry out the unconditional log of the suspected risk factors. Istic regression analysis.
Results: a total of 228 cases of preterm infants, NRDS62 cases, incidence of 27.2%. single factor analysis showed that the factors associated with the incidence of NRDS were: birth weight, fetal age, Apgar score, amniotic fluid, premature rupture of membranes, prenatal hormones, neonatal septicemia, sex, mode of delivery, intrauterine infection, and antenatal antibiotics were not statistically different. Multifactor logisti C regression analysis showed: low birth weight (OR=21.724,95%CI:13.541,86.239), small fetal age (OR=33.709,95%CI:21.584126.479), low Apgar score (OR=18.370,95%CI:7.015,67.403), amniotic fluid (OR=3.250,95%CI:1.118,11.020) / III degree pollution (OR=8.207,95%CI: 1.083,17.217), premature rupture of membranes (OR=2.550,95%CI:3.113,9.294), neonatal failure Anemia (OR=3.103,95%CI:1.332,7.229) can increase the risk of NRDS, and antenatal hormone (OR=0.299,95%CI:0.125,0.717) can prevent the occurrence of NRDS.
Conclusion: infection related factors: amniotic fluid pollution, premature rupture of membranes and neonatal septicemia are risk factors for NRDS. Intrauterine infection is not a risk factor for NRDS.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R722.1

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