本文關(guān)鍵詞： 胎兒生長(zhǎng)受限 危險(xiǎn)因素 圍產(chǎn)兒結(jié)局 早發(fā)型 晚發(fā)型　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討胎兒生長(zhǎng)受限(FGR)發(fā)病的危險(xiǎn)因素及對(duì)圍產(chǎn)兒結(jié)局的影響,為臨床上正確干預(yù),降低胎兒生長(zhǎng)受限發(fā)病率,提高嬰兒健康水平提供一定的理論基礎(chǔ)。方法回顧性分析2011年07月至2016年03月在陸軍總醫(yī)院婦產(chǎn)科收治的FGR,將符合入選標(biāo)準(zhǔn)的213例母兒患者作為FGR組,同期(在入選FGR組的上一例或下一例)住院分娩(包括引產(chǎn))的健康母兒患者為對(duì)照組。采集基本信息包括孕產(chǎn)婦姓名,年齡,孕產(chǎn)史,分娩孕周。本次孕期情況:妊娠期并發(fā)癥、分娩時(shí)間、分娩方式、新生兒出生體重、新生兒結(jié)局等臨床資料,分析FGR發(fā)病的危險(xiǎn)因素、及不同發(fā)病孕周、分娩時(shí)間、分娩方式對(duì)圍產(chǎn)兒結(jié)局的影響。結(jié)果1.我院FGR的發(fā)病率為1.92%,低于我國(guó)所報(bào)道的發(fā)病率(6.39%);經(jīng)產(chǎn)前超聲診斷171例,分娩后診斷42例,產(chǎn)前診斷率為80.28%。2.FGR組與對(duì)照組的年齡、孕次、產(chǎn)次、分娩孕周的比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組FGR危險(xiǎn)因素的比較,FGR組的妊娠期高血壓疾病、羊水異常、臍血流異常的發(fā)生率明顯高于對(duì)照組,差異顯著有統(tǒng)計(jì)學(xué)意義(P0.05)。有妊娠期高血壓疾病的孕產(chǎn)婦患FGR危險(xiǎn)性是無(wú)妊娠期高血壓疾病的2.523倍,有羊水異常的發(fā)病是羊水正常的2.496倍,有臍血流異常的發(fā)病風(fēng)險(xiǎn)增加了4.297倍。3.將發(fā)生FGR的213例患者分為早發(fā)型組(發(fā)病孕周為≤32周),晚發(fā)型組(發(fā)病孕周為32周),早發(fā)型組主要危險(xiǎn)因素為妊娠期高血壓疾病、臍血流異常,晚發(fā)型組主要因素為羊水異常;妊娠期高血壓疾病、臍血流異常在早發(fā)型組明顯高于晚發(fā)型組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。晚發(fā)型組的1min Apgar評(píng)分、5min Apgar評(píng)分、10min Apgar評(píng)分、新生兒體重均較早發(fā)型組高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),而轉(zhuǎn)兒科率及圍產(chǎn)兒死亡率均以早發(fā)型組發(fā)生率較高,但僅后者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.按分娩孕周不同將FGR組分為三組:第1組為≤33+6周,第2組為34-36+6周,第3組為37-42周,各組的新生兒體重(分別為1455.8±369.2 g、2053.3±325.5 g、2611.3±393.5 g),以第3組最高,差異顯著有統(tǒng)計(jì)學(xué)意義(P0.05),新生兒窒息(各組發(fā)生率分別為12.5%、6.45%、1.35%),轉(zhuǎn)兒科率(各組發(fā)生率分別為75%、70.97%、24.32%),圍產(chǎn)兒死亡(各組發(fā)生率分別為15.79%、8.82%、0.67%),比較各組發(fā)生率均可見(jiàn)顯著差異(p0.001)。5.FGR組中有較高的剖宮產(chǎn)率(69.48%),急診剖宮產(chǎn)有79例,擇期剖宮產(chǎn)有69例,對(duì)手術(shù)指征進(jìn)行統(tǒng)計(jì),產(chǎn)時(shí)胎兒窘迫居于急診剖宮產(chǎn)原因的首位(40.5%)。結(jié)論1.我院于2011年07月至2016年03月期間FGR的發(fā)病率為1.92%,產(chǎn)前診斷率為80.28%。2.妊娠期高血壓疾病、臍血流異常、羊水異常是FGR發(fā)病的危險(xiǎn)因素。3.早發(fā)型FGR具有高合并癥的特點(diǎn),新生兒結(jié)局較差,要合理管理早發(fā)型FGR、旨在改善新生兒預(yù)后。4.胎齡是影響FGR圍產(chǎn)兒結(jié)局的關(guān)鍵因素,母嬰情況允許的條件下,可適當(dāng)延長(zhǎng)孕周,根據(jù)個(gè)體化原則,適時(shí)、適宜方式終止妊娠,有利于提高患兒生存質(zhì)量。
[Abstract]:Objective to explore the risk factors of FGRand its influence on perinatal outcome in order to correct clinical intervention and reduce the incidence of fetal growth restriction. Methods from July 2011 to March 2016, two hundred and thirteen mothers and infants who were admitted to the General Army Hospital in the Department of Gynecology and Obstetrics and Obstetrics and Gynecology and Obstetrics and Gynecology, were selected as FGR group. During the same period (one or the next in the FGR group), healthy mothers and infants who were hospitalized to give birth (including induced labor) served as the control group. Basic information was collected, including the name, age, history of pregnancy and childbirth. Pregnancy: complications of pregnancy, delivery time, delivery mode, birth weight of newborn, neonatal outcome and other clinical data, analysis of the risk factors of FGR, as well as different gestational weeks, delivery time, Results 1. The incidence of FGR in our hospital was 1.92 2, which was lower than 6.39% reported in our country, 171 cases were diagnosed by prenatal ultrasound, 42 cases were diagnosed after delivery, the rate of prenatal diagnosis was 80.28.2.The age and pregnancy of FGR group and control group were 80.28. 2. There was no significant difference in the risk factors of FGR between the two groups. The incidence of abnormal amniotic fluid and umbilical blood flow in the FGR group was significantly higher than that in the control group. The risk of FGR in pregnant women with hypertensive disorder complicating pregnancy was 2.523 times higher than that without gestational hypertension, and the incidence of amniotic fluid abnormality was 2.496 times higher than that of normal amniotic fluid. The risk of abnormal umbilical blood flow was increased by 4.297-fold. 3. The patients with FGR were divided into early onset group (gestational age 鈮，

本文編號(hào)：1521662