本文選題：妊娠期　切入點：細菌性陰道病　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:細菌性陰道病(Bacterial vaginosis,BV)系陰道菌群失調的一種疾病。正常陰道內乳酸桿菌為優(yōu)勢菌群,當高濃度的陰道加德納菌、各種厭氧菌及人型支原體替代其成為主要菌群時即會發(fā)病。妊娠期BV的發(fā)病率約為10%-50%,且妊娠期BV的檢出率遠高于陰道滴蟲及陰道假絲酵母菌病者,是妊娠期最常見的陰道感染。研究發(fā)現(xiàn)BV與胎膜早破(premature rupture of membrane,PROM)、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎、胎兒宮內窘迫、新生兒宮內感染等母兒不良結局相關。傳統(tǒng)的治療妊娠期細菌性陰道病的方法是口服甲硝唑治療,這種治療方法有難以避免的副作用,最常見的主訴是口腔內有特殊的金屬異味,也有頭痛眩暈、惡心嘔吐、下腹痛等不適主訴。患者對于孕期口服甲硝唑普遍不能接受,而且口服甲硝唑治療后會導致繼發(fā)性陰道假絲酵母病,其發(fā)生率是5%到22%�，F(xiàn)需要一種安全、有效、依從性高的治療方法。本研究采用甲硝唑陰道上藥聯(lián)合維生素C(Vitamin C)口服治療細菌性陰道病,觀察其治愈率和母兒結局改變情況。方法:本研究采用回顧性分析方法,查找2013年2月至2016年6月于大連醫(yī)科大學附屬第二醫(yī)院門診就診的妊娠期細菌性陰道病患者共計244例,平均年齡(29±3)歲,治療起始孕周為24-28周,平均治療起始孕周(26±2)周;健康孕婦56例(平均年齡28±2歲,自妊娠28周起隨訪)。將妊娠期細菌性陰道病患者分成三組:A組應用甲硝唑陰道上藥聯(lián)合維生素C口服115例,平均年齡(30±3)歲,平均治療起始孕周(25±6)周;B組單獨應用甲硝唑陰道上藥82例,平均年齡(27±3)歲,平均治療起始孕周為(26±1)周,C組單獨應用維生素C口服47例,平均年齡(29±2)歲,平均治療起始孕周(26±4)周;比較A、B、C三組的治愈率。D組為對照組,健康孕婦56例(平均年齡28±2歲,自妊娠28周起隨訪)。比較四組患者胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎的發(fā)生率,及胎兒窘迫、新生兒感染的發(fā)生率,是否具有統(tǒng)計學意義。在300例患者中,按如下條件共選出180例。⑴初產婦;⑵頭位;⑶既往體健;⑷無腹部手術史;⑸產檢中未發(fā)現(xiàn)其他剖宮產指征,符合陰道試產標準。其中A組61例,B組29例,C組42例,D組患者48例。比較四組患者的分娩孕周。所有資料均采用SPSS 20.0統(tǒng)計軟件進行數(shù)據(jù)處理,計數(shù)資料采用χ2檢驗,等級資料用秩和檢驗,P0.05有統(tǒng)計學意義。結果:1.A組的治愈率為92%,B組的治愈率為41%,C組的治愈率為83%。治療組A、B、C三組的治愈率有統(tǒng)計學差異,A組的治愈率高于B組,高于C組。2.1 A組在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎的發(fā)生率分別為7.83%,0.87%,0.00%,1.74%,0.87%;B組在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎的發(fā)生率分別為48.9%,10.64%,4.26%,8.51%,6.38%;C組在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎的發(fā)生率分別為17.07%,2.44%,1.22%,2.44%,1.22%;D組在胎膜早破、早產、絨毛膜羊膜炎、羊水腔感染、產后子宮內膜炎的發(fā)生率分別為5.36%,0.00%,0.00%,1.79%,0.00%。A組在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎等妊娠不良結局低于B、C組。A組與D組在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎等妊娠不良結局無統(tǒng)計學意義。B與D、C與D在胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎等妊娠不良結局有統(tǒng)計學意義2.2 A組在胎兒窘迫、新生兒感染的發(fā)生率分別為9.57%,2.61%;B組在胎兒窘迫、新生兒感染的發(fā)生率分別為31.91%,17.02%:C組在胎兒窘迫、新生兒感染的發(fā)生率分別為25.61%,12.20%;D組在胎兒窘迫、新生兒感染的發(fā)生率分別為7.15%,1.19%。A組在胎兒窘迫、新生兒感染的發(fā)病率低于B組、C組,與D組無統(tǒng)計學差異。B組與D組,C組與D組在胎兒窘迫、新生兒感染的發(fā)病率有統(tǒng)計學差異。3.A組的分娩孕周在大于39周比例為52.46%;B組的分娩孕周在37-38周比例為65.52%;C組的分娩孕周在38-39周比例為59.52%,D組的分娩孕周在大于39周比例為64.58%。四組分娩孕周不同,四組分娩孕周有統(tǒng)計學差異。結論:1.甲硝唑聯(lián)合維生素C治療細菌性陰道病的治愈率高于單獨應用甲硝唑陰道上藥,高于單獨口服維生素C。2.甲硝唑聯(lián)合維生素C治療細菌性陰道病有效改善胎膜早破、早產、絨毛膜羊膜炎、羊膜腔感染、產后子宮內膜炎等妊娠不良結局,也同時改善胎兒窘迫及新生兒感染等新生兒不良結局,此治療方法的妊娠不良結局及新生兒不良結局與健康孕婦相似。3.應用甲硝唑聯(lián)合維生素C治療細菌性陰道病較單獨應用甲硝唑,單獨使用維生素C患者孕周延長。
[Abstract]:Objective: bacterial vaginosis (Bacterial vaginosis, BV), the vaginal flora of a disease. The normal vaginal Lactobacillus as the dominant bacteria, when Gardiner vaginal bacteria with high concentration, various anaerobic bacteria and Mycoplasma hominis instead become the main flora is the incidence of pregnancy. The incidence of BV the rate is about 10%-50%, and the BV pregnancy rate is much higher than that of trichomonas and Candida disease, is the most common pregnancy vaginal infection. We found that the BV and premature rupture of membranes (premature rupture of membrane, PROM), preterm birth, chorioamnionitis, postpartum endometritis, amniotic cavity infection, fetal distress, adverse neonatal outcome of intrauterine infection of mother and fetus. The traditional method of treatment of bacterial vaginosis in pregnancy is oral metronidazole treatment, this treatment is difficult to avoid the side effects, the most common complaint is special in the mouth It also has the metallic smell, headache and dizziness, nausea and vomiting, abdominal pain and other discomfort. For patients with pregnancy generally cannot accept oral metronidazole, and oral metronidazole treatment will lead to secondary vaginal Candida disease, its incidence is 5% to 22%. we need a safe and effective treatment method, high compliance. This study used metronidazole vaginal irrigation combined with vitamin C (Vitamin C) oral treatment of bacterial vaginosis, observe the cure rate and perinatal outcomes changes. Methods: This study used a retrospective analysis from February 2013 to June 2016, to find the pregnancy with bacterial vaginosis in the outpatient department of the Second Affiliated Hospital of Dalian Medical University, a total of 244 Cases, the average age (29 + 3) years old, starting treatment of gestational age was 24-28 weeks, the average gestational weeks of treatment initiation (26 + 2) weeks; 56 healthy pregnant women (mean age 28 + 2 years, since the 28 weeks of pregnancy follow-up). 濡婂鏈熺粏鑿屾，

本文編號：1569371