本文關(guān)鍵詞： 胎膜早破 高危因素 圍產(chǎn)結(jié)局 剩余羊水量　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討胎膜早破患者高危因素及圍產(chǎn)結(jié)局;分析早產(chǎn)胎膜早破剩余羊水量與圍產(chǎn)結(jié)局的關(guān)系。方法:(1)2013-01到2016-03于陸軍總醫(yī)院(以下簡稱我院)住院分娩的6775例孕婦中,選取發(fā)生胎膜早破的1105例患者臨床資料作為研究對象,依據(jù)破膜時的孕周,劃為A組(早產(chǎn)胎膜早破組,n=193)和B組(足月胎膜早破組,n=912),采用回顧性研究方法對A、B兩組高危因素及圍產(chǎn)結(jié)局進行整理及統(tǒng)計學(xué)分析,采用多因素非條件Logistic回歸分析導(dǎo)致早產(chǎn)胎膜早破的獨立危險因素;(2)早產(chǎn)胎膜早破組中,除多胎妊娠以及合并其他疾病者21例外,剩余172例,根據(jù)早產(chǎn)胎膜早破后剩余羊水指數(shù)(amniotic fluid index,AFI)劃為C1組(剩余羊水量過少組,AFI"f5cm,n=20)、C2組(偏少組,5cmAFI"f8cm,n=24)及C3組(正常組,8cmAFI25cm,n=128),采用回顧性研究方法比較三組圍產(chǎn)結(jié)局。結(jié)果:1.我院胎膜早破發(fā)病率為16.3%,其中早產(chǎn)胎膜早破為2.8%,足月胎膜早破為13.5%。2.我院住院分娩孕婦中,致使胎膜早破的高危因素主要有:流產(chǎn)及引產(chǎn)史、生殖道感染、妊娠合并糖尿病、胎位異常、巨大兒、妊娠期高血壓疾病、妊娠合并貧血、多胎妊娠、子宮畸形、羊水過多、前置胎盤、宮頸機能不全等。3.A組與B組相比,生殖道感染的發(fā)生率分別是39.9%、18.8%,多胎妊娠的發(fā)生率分別是7.3%、0.1%,胎位異常(頭盆不稱/臀位/橫位)的發(fā)生率分別是19.2%、10.9%,流產(chǎn)及引產(chǎn)史的發(fā)生率分別是48.7%、36.5%,妊娠期高血壓疾病的發(fā)生率分別是5.7%、1.9%,妊娠合并糖尿病的發(fā)生率分別是22.3%、14.3%,前置胎盤的發(fā)生率分別是2.1%、0.2%,妊娠合并貧血的發(fā)生率分別是5.2%、2.0%,差異均具有統(tǒng)計學(xué)意義(p0.05)。4.導(dǎo)致早產(chǎn)胎膜早破的多因素非條件Logistic回歸分析結(jié)果顯示:生殖道感染、多胎妊娠、胎位異常、流產(chǎn)及引產(chǎn)史、前置胎盤以及妊娠合并貧血均是影響早產(chǎn)胎膜早破發(fā)生的獨立危險因素(OR值分別為3.387,3.533,1.680,1.635,3.020,3.177,95%CI:1.468~13.337,1.892~13.993,1.005~2.807,1.127~2.372,1.841~15.977,1.294~7.798,p0.05)。5.A組與B組相比,剖宮產(chǎn)分娩率分別是56.0%、46.6%,產(chǎn)褥感染的發(fā)病率分別是6.2%、3.3%,新生兒肺炎的發(fā)病率分別是3.6%、1.4%,新生兒窒息的發(fā)病率分別是4.7%、0.8%,差異均具有統(tǒng)計學(xué)意義(p0.05)。6.C1組(羊水過少組)平均分娩孕周、新生兒出生體重及男嬰分娩率分別是32.56±3.18周,1956.2±703.0g,75.0%;C2組(羊水偏少組)分別為34.15±2.35周,2341.7±585.7g,70.8%;C3組(羊水正常組)分別為34.37±2.19周,3440.5±605.1g,51.6%;三組相比較,羊水越少,新生兒分娩孕周越小、出生體重越低,而男嬰分娩率越高,差異均具有統(tǒng)計學(xué)意義(P0.05)。7.C1組低出生體重兒、新生兒窒息、新生兒呼吸窘迫綜合征、1分鐘Apgar評分"f7分,以及產(chǎn)后子宮內(nèi)膜炎的發(fā)病率明顯高于另外兩組,差異有統(tǒng)計學(xué)意義(χ2=6.434,9.238,9.073,9.238,9.073;P0.05),而三組間剖宮產(chǎn)分娩、潛伏時間、胎兒窘迫、絨毛膜羊膜炎、產(chǎn)后出血的發(fā)病率比較,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)我院胎膜早破發(fā)病率為16.3%,其中早產(chǎn)胎膜早破為2.8%,足月胎膜早破為13.5%,較文獻報道略高。(2)我院胎膜早破最常見的誘因為流產(chǎn)及引產(chǎn)史、生殖道感染等。生殖道感染、多胎妊娠、胎位異常、流產(chǎn)及引產(chǎn)史、前置胎盤、妊娠合并貧血是PPROM發(fā)病的獨立危險因素。(3)胎膜早破尤其是早產(chǎn)胎膜早破,可導(dǎo)致剖宮產(chǎn)分娩、產(chǎn)褥感染、新生兒肺炎及新生兒窒息的發(fā)病率明顯增加。(4)早產(chǎn)胎膜早破剩余羊水量過少可引起胎兒分娩孕周提前、新生兒窒息、新生兒呼吸窘迫綜合征、產(chǎn)后子宮內(nèi)膜炎等不良圍產(chǎn)結(jié)局。
[Abstract]:Objective: To investigate the risk factors of patients with premature rupture of membranes and perinatal outcomes; analysis of the relationship between premature rupture of residual amniotic fluid volume and perinatal outcome. Methods: (1) 2013-01 to 2016-03 in the Army General Hospital (hereinafter referred to our hospital) in 6775 cases of pregnant women hospitalized delivery, choice of the clinical data of 1105 cases of premature rupture of membranes broken as the research object, based on the broken film weeks of gestation, designated as A group (the group of premature rupture of membranes, n=193) and B group (PROM group, n=912), a retrospective study of A, B two groups of risk factors and perinatal outcome analysis and statistics, the multi factor non conditional Logistic regression analysis to independent risk factors for preterm premature rupture of membranes; (2) the group of premature rupture of membranes, in addition to multiple pregnancy and associated with other diseases in 21 cases, the remaining 172 cases, according to the number of residual amniotic fluid after preterm premature rupture of the membranes (amniotic fluid, index, AFI) designated as C 1緇，

本文編號：1518489