本文關(guān)鍵詞：胎膜早破383例臨床分析　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胎膜早破 期待治療 終止妊娠時(shí)機(jī) 終止妊娠方式 圍生兒

【摘要】：目的：探討不同孕齡胎膜早破終止妊娠時(shí)機(jī)、終止妊娠指征，合理選擇終止妊娠方式，從而改善圍生兒預(yù)后，綜合考慮母兒因素，盡可能使母兒益處達(dá)到最大化。 方法：回顧性分析383例胎膜早破患者的臨床資料，并對(duì)其合理分組討論和統(tǒng)計(jì)學(xué)處理。 研究一：根據(jù)胎膜早破發(fā)生時(shí)孕周不同分組：A組：28-32周（64例），B組：32+1-34周（64例），C組：34+1-36周（104例），D組：＞36周（151例）。 研究二：根據(jù)終止妊娠時(shí)孕周分組：I組：28-32周（49例），II組：32+1-34周（61例），III組：34+1-36周（107例），，IV組：＞36周（166例）。 結(jié)果：研究一：1、383例PROM按胎膜早破發(fā)生時(shí)孕周不同分組，年齡、孕次比較差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。2、孕28-32周PROM的新生兒應(yīng)用呼吸機(jī)、新生兒呼吸窘迫綜合癥、新生兒感染、顱內(nèi)出血、死亡的發(fā)生率最高，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。3、總體來看，隨著期待治療時(shí)間的延長(zhǎng)，感染的發(fā)生率均增高。4、對(duì)于28+1-34周的PROM，適當(dāng)給予期待治療延長(zhǎng)孕周，新生兒呼吸窘迫綜合癥的發(fā)生率顯著降低。 研究二：1、I組和II組終止妊娠主要是因?yàn)樘阂蛩�，分別占40.8%、39.3%。III組和IV組終止妊娠原因主要是臨產(chǎn)，分別占42.1%、63.9%。2、隨著終止妊娠的孕周增大，因臨產(chǎn)而終止妊娠比率逐漸增加，而胎兒因素和母體因素逐漸降低。3、隨著終止妊娠孕周增大，剖宮產(chǎn)率逐漸升高，陰道分娩率逐漸降低，IV組孕婦剖宮產(chǎn)率達(dá)71.7%、陰道分娩率低至28.3%。4、I組和II組剖宮產(chǎn)分娩可明顯降低顱內(nèi)出血發(fā)生率（P＜0.05）。III組和IV組在顱內(nèi)出血方面剖宮產(chǎn)分娩和陰道分娩無統(tǒng)計(jì)學(xué)差異（P＞0.05）。各組內(nèi)不同分娩方式對(duì)新生兒其他患病情況無統(tǒng)計(jì)學(xué)差異（P＞0.05）。 結(jié)論：1、胎膜早破發(fā)生越早，新生兒預(yù)后越差，根據(jù)胎膜早破主要病因，孕期應(yīng)給予積極有效的預(yù)防措施。2、對(duì)于妊娠小于32周的PROM，在嚴(yán)密監(jiān)測(cè)孕婦和胎兒各項(xiàng)指標(biāo)的情況下，可以采用期待療法延長(zhǎng)孕周至32周，以減少新生兒患病率和死亡率。3、32+1-34周的PROM如無感染征象，可適當(dāng)延長(zhǎng)孕周；如有感染可能，適時(shí)終止妊娠。4、大于34周的PROM，可不給予保胎治療，可根據(jù)實(shí)際情況順其自然等待產(chǎn)程發(fā)動(dòng)或給予積極催產(chǎn)誘導(dǎo)其產(chǎn)程發(fā)動(dòng)。5、對(duì)于胎膜早破終止妊娠方式的選擇，目前研究不同終止妊娠方式對(duì)新生兒總體預(yù)后無顯著差異，在臨床工作中應(yīng)根據(jù)實(shí)際情況、權(quán)衡利弊、充分溝通后個(gè)體化選擇終止妊娠方式。
[Abstract]:Objective: to explore the timing of termination of pregnancy with premature rupture of membranes at different gestational ages, the indication of termination of pregnancy, and the reasonable choice of termination mode of pregnancy, so as to improve the prognosis of perinatal and to consider the factors of mother and infant. Maximize the benefits of motherhood as much as possible. Methods: the clinical data of 383 patients with premature rupture of membranes were analyzed retrospectively. Study 1: according to the gestational weeks of premature rupture of membranes, 64 cases of group B were divided into two groups: group A: 64 cases: group B: 32 ~ 34 weeks (n = 64). Group C (n = 104): > 36 weeks (n = 151). Study 2: according to the gestational week of termination of pregnancy, we divided into two groups: group I: 28-32 weeks and 49 cases: group II: 32-34 weeks and 61 cases; group III: 34-36 weeks (107 cases). Group IV: 166 cases were > 36 weeks old. Results: there were no significant differences in age and pregnancy in 383 cases of PROM according to the gestational weeks of premature rupture of membranes (P > 0. 05, P > 0. 05, P > 0. 05, P > 0. 05). Neonatal respiratory distress syndrome (RDS), neonatal infection, intracranial hemorrhage and the highest incidence of death were found in 28 to 32 weeks of gestation with PROM. The difference was statistically significant (P < 0.05). In general, with the prolongation of the expected treatment time, the incidence of infection increased by .4for PROM from 28 to 34 weeks. The incidence of neonatal respiratory distress syndrome was significantly reduced by appropriate expectant treatment for prolonged gestational weeks. In the study, the termination of pregnancy in group I and group II was mainly due to fetal factors, accounting for 40.8% 39.3.III and IV respectively. With the increase of gestational weeks, the ratio of termination of pregnancy due to labor gradually increased, while the fetal factors and maternal factors decreased gradually. With the increase of termination of pregnancy, the rate of cesarean section gradually increased, the rate of vaginal delivery decreased gradually, the rate of cesarean section in group IV was 71.7, and the rate of vaginal delivery was as low as 28.3.4. Caesarean delivery in group I and group II significantly reduced the incidence of intracranial hemorrhage (P < 0.05). There was no significant difference between caesarean delivery and vaginal delivery (P < 0.05). There was no significant difference between different delivery modes and other neonatal diseases in each group (P > 0.05). Conclusion: the earlier the premature rupture of membranes occurs, the worse the prognosis of newborns is. According to the main etiology of premature rupture of membranes, active and effective preventive measures should be taken during pregnancy, and PROM is less than 32 weeks of gestation. With closely monitored maternal and fetal indicators, expectant therapy can be used to extend the gestational age to 32 weeks in order to reduce neonatal morbidity and mortality. 32 to 34 weeks of PROM may extend gestational weeks if there are no signs of infection. If infection is possible, timely termination of pregnancy. 4, more than 34 weeks of Prom, can not be given fetal treatment, can be based on the actual situation waiting for the process of starting or giving active induction of labor induction of labor process launch .5. For the choice of termination of pregnancy with premature rupture of membranes, there is no significant difference in the overall prognosis of newborns in the study of different termination of pregnancy. In clinical work, we should weigh the advantages and disadvantages according to the actual situation. Individual choice of termination of pregnancy after full communication.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.433

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