本文關(guān)鍵詞： 晚期先兆流產(chǎn) 難免流產(chǎn) 感染 保胎結(jié)局　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)對(duì)可能影響晚期先兆流產(chǎn)保胎結(jié)局的各相關(guān)因素分析，以便盡早發(fā)現(xiàn)原因，早期干預(yù)治療，，提高保胎成功率，避免難免流產(chǎn)的發(fā)生。 方法：選自2012年4月-2013年3月在大連市婦產(chǎn)醫(yī)院因晚期先兆流產(chǎn)住院保胎的患者共227例，其中保胎成功181例，保胎成功率79.7%；難免流產(chǎn)46例，保胎失敗率20.3%。所有患者入院時(shí)均詳細(xì)詢問(wèn)病史，并行血常規(guī)、CRP（C-反應(yīng)蛋白）、甲狀腺功能、血病毒、超聲、陰道分泌物及宮頸分泌物培養(yǎng)，分析可能影響保胎結(jié)局的因素。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的處理，計(jì)量資料采用t檢驗(yàn)，計(jì)數(shù)資料采用χ2檢驗(yàn)，多因素分析采用非條件Logistic回歸分析，預(yù)測(cè)價(jià)值采用診斷試驗(yàn)的ROC分析，P＜0.05具有統(tǒng)計(jì)學(xué)差異。 結(jié)果：保胎成功組與難免流產(chǎn)組比較，平均年齡、孕周無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05），住院時(shí)間具有統(tǒng)計(jì)學(xué)差異（P＜0.05）,保胎成功組住院時(shí)間長(zhǎng)；兩組之間比較，貧血、反復(fù)性自然流產(chǎn)（RSA）、感染、宮頸機(jī)能不全經(jīng)宮頸環(huán)扎術(shù)具有統(tǒng)計(jì)學(xué)差異（P＜0.05）；多因素非條件Logistic回歸分析顯示，感染、宮頸機(jī)能不全經(jīng)宮頸環(huán)扎術(shù)具有統(tǒng)計(jì)學(xué)差異（P＜0.05），感染是難免流產(chǎn)的獨(dú)立危險(xiǎn)因素OR=5.796，宮頸機(jī)能不全經(jīng)宮頸環(huán)扎術(shù)是難免流產(chǎn)的獨(dú)立保護(hù)因素OR=0.076；兩組之間比較，支原體感染、活動(dòng)性梅毒具有統(tǒng)計(jì)學(xué)差異（P＜0.05）；隨著血白細(xì)胞、中性粒細(xì)胞百分比、中性粒細(xì)胞絕對(duì)值、CRP值的升高，難免流產(chǎn)率上升，保胎成功率下降，兩組之間比較具有統(tǒng)計(jì)學(xué)差異（P＜0.05）；通過(guò)ROC曲線分析，血白細(xì)胞、中性粒細(xì)胞百分比、中性粒細(xì)胞絕對(duì)值、CRP對(duì)預(yù)測(cè)難免流產(chǎn)具有統(tǒng)計(jì)學(xué)差異（P＜0.05）。 結(jié)論：1、影響晚期先兆流產(chǎn)保胎結(jié)局的因素有貧血、RSA、感染、宮頸機(jī)能不全經(jīng)宮頸環(huán)扎術(shù)，其中感染是難免流產(chǎn)的獨(dú)立危險(xiǎn)因素，宮頸機(jī)能不全經(jīng)宮頸環(huán)扎術(shù)是難免流產(chǎn)的獨(dú)立保護(hù)因素。 2、晚期先兆流產(chǎn)患者感染支原體、活動(dòng)性梅毒時(shí)，難免流產(chǎn)率增加。 3、晚期先兆流產(chǎn)患者血白細(xì)胞、中性粒細(xì)胞、CRP值越高，保胎成功率越低，難免流產(chǎn)率越高。 4、血白細(xì)胞、中性粒細(xì)胞、CRP值對(duì)患者難免流產(chǎn)具有中等預(yù)測(cè)價(jià)值，這為臨床醫(yī)生是否使用抗生素治療提供一定的依據(jù)，其中CRP對(duì)難免流產(chǎn)預(yù)測(cè)價(jià)值最大。
[Abstract]:Objective: to analyze the related factors that may affect the outcome of late threatened abortion, so as to find out the cause as soon as possible, to intervene in early treatment, to improve the success rate of fetal preservation and to avoid the inevitable abortion. Methods: from April 2012 to March 2013, 227 cases were admitted to Dalian Gynecology Hospital for late threatened abortion, including 181 cases of successful fetal preservation, 79.7% success rate of fetal preservation, 46 cases of inevitable abortion. The failure rate of fetal protection was 20.3.All the patients were asked about the history of the disease at admission, followed by blood routine examination of CRPP-C-reactive protein, thyroid function, blood virus, ultrasound, vaginal secretion and cervical secretion culture. The factors that may affect the outcome of fetal preservation were analyzed. The data were processed by SPSS17.0 statistical software. T test was used for measurement data, 蠂 2 test was used for counting data, and non-conditional Logistic regression analysis was used for multivariate analysis. The predictive value was statistically different by ROC analysis of diagnostic test (P < 0. 05). Results: there was no significant difference in average age and gestational age between successful group and inevitable abortion group (P > 0.05), and there was significant difference in hospitalization time (P < 0.05). There was statistical difference in cervical insufficiency by cervical ring ligation (P < 0. 05). Multivariate non conditional Logistic regression analysis showed that infection was found. There was statistical difference in cervical insufficiency through cervical ring ligation (P < 0.05). Infection was an independent risk factor of inevitable abortion, OR5.796. Cervix dysfunctions via cervix cervicalis was the independent protective factor of inevitable miscarriage (OR0.076), and mycoplasma infection was compared between the two groups. The difference of active syphilis was statistically significant (P < 0.05). With the increase of the percentage of white blood cells, neutrophils, absolute values of neutrophil and CRP, the abortion rate increased and the success rate of fetal preservation decreased. By ROC curve analysis, the percentage of white blood cells, neutrophils and neutrophils were significantly different in predicting inevitable abortion (P < 0.05). Conclusion 1. The factors affecting the outcome of late threatened abortion are anemia, RSA, infection and cervical insufficiency through cervix, among which infection is the independent risk factor of inevitable abortion. Cervical insufficiency through cervix is an independent protective factor of inevitable abortion. 2, late threatened abortion patients infected with mycoplasma, active syphilis, inevitable abortion rate increased. 3. The higher the level of leukocyte and neutrophil CRP in patients with late threatened abortion, the lower the success rate of fetal preservation and the higher the rate of inevitable abortion. 4. The values of leukocyte and neutrophil CRP have moderate predictive value for inevitable abortion, which provides a certain basis for clinicians to use antibiotic therapy, among which CRP is the most valuable predictor of inevitable abortion.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.21

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