本文選題：體外受精　切入點：胚胎移植　出處：《河北醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討經(jīng)過體外受精-胚胎移植技術(shù)(IVF-ET)受孕后出生的試管嬰兒與自然受孕出生的新生兒的宮內(nèi)生長發(fā)育情況、新生兒合并癥及母親圍產(chǎn)期的并發(fā)癥，進而以評價人類輔助生殖技術(shù)(Assisted ReproductiveTechnology，ART)的安全性及可行性,為試管嬰兒的臨床救治提供指導(dǎo)。 方法：研究對象為2011年1月至2013年12月期間，在河北醫(yī)科大學第二醫(yī)院接受IVF-ET的178例母親所生的活產(chǎn)嬰兒264例(試管嬰兒組)，包括單胎92例，雙胎85例，三胎1例,其中死嬰1例；及隨機抽取的同期分娩自然受孕的241例母親所生的活產(chǎn)嬰兒256例(自然受孕組)：其中單胎226例，雙胎15例。通過對試管嬰兒組及自然受孕組的臨床分析，比較兩組的母親年齡、是否多胎、剖宮產(chǎn)率、早產(chǎn)率、妊娠期合并癥及胎兒的宮內(nèi)窘迫、同時還比較兩組新生兒的生后窒息、先天缺陷、生長發(fā)育情況及生后合并癥。結(jié)果用SPSS13.0軟件包進行統(tǒng)計學處理，兩組的計量資料應(yīng)用t檢驗，計數(shù)資料采用卡方檢驗方法，數(shù)據(jù)服從正態(tài)性分布的用均數(shù)±標準差(x±s)表示，P0.05為差異有統(tǒng)計學意義。 結(jié)果： 1在多胎妊娠與早產(chǎn)方面試管嬰兒組與自然受孕組的比較：試管嬰兒組多胎妊娠率為48.3%(86/178)，自然受孕組的多胎妊娠率是6.2%(15/241)，差異有統(tǒng)計學意義(X2為99.145，P0.05)；試管嬰兒組的早產(chǎn)發(fā)生率為40.4%(72/178)，自然受孕組早產(chǎn)率為19.5%(47/241)，兩組差異有統(tǒng)計學意義(X2為22.092，P0.05)。 2母親年齡及剖宮產(chǎn)方面試管嬰兒組與自然受孕組的比較：試管嬰兒組母親平均年齡為33.53±4.69歲，自然受孕組母親平均年齡為27.76±3.93歲，兩組差異有統(tǒng)計學意義(t為13.337，P0.05)；試管嬰兒組剖宮產(chǎn)率為81.5%(145/178)，自然受孕組剖宮產(chǎn)率為51.0%(123/241),兩組差異有統(tǒng)計學意義(X2為41.111，P0.05)。 3妊娠期糖尿病和妊娠期高血壓(簡稱妊高癥)方面試管嬰兒組與自然受孕組的比較：試管嬰兒組母親患妊娠期糖尿病的有9.0%(16/178)，，自然受孕組有4.1%(10/241),兩組差異有統(tǒng)計學意義(X2為4.120，P0.05)；試管嬰兒組母親妊高癥發(fā)生率為25.8%(46/178)，自然受孕組發(fā)生率為14.5%(35/241),兩組差異有統(tǒng)計學意義(X2為8.413，P0.05)。 4試管嬰兒組胎盤異常的有4.5%(8/178)，臍帶異常的有18.0%(32/178)，胎膜早破的有14.0%(25/178)，自然受孕組胎盤異常為5.4%(13/241)、臍帶異常為21.2%(51/241)、胎膜早破的有8.7%(21/241),兩組在胎盤、臍帶異常及胎膜早破上差異均無統(tǒng)計學意義(P0.05)。 5試管嬰兒組與自然受孕組在宮內(nèi)窘迫及生后窒息方面的比較：試管嬰兒組宮內(nèi)窘迫的發(fā)生率是6.7%(12/178)，自然受孕組是3.3%(8/241)；試管嬰兒組生后窒息的有10.6%(28/264)，自然受孕組有7.8%(20/256),兩組在宮內(nèi)窘迫及生后窒息上差異均無統(tǒng)計學意義(P0.05)。 6試管嬰兒組新生兒生后轉(zhuǎn)兒科的有43.2%(114/264)，自然受孕組有31.6%(81/256)，差異有統(tǒng)計學意義(X2為7.386，P0.05)。 7在宮內(nèi)生長發(fā)育方面，試管嬰兒組小于胎齡兒占8.3%(22/264),適于胎齡兒占85.6%(226/264),大于胎齡兒占6.1%(16/264),自然受孕組分別占7.8%(20/256)，83.2%(213/256)，9.0%(23/256),兩組在宮內(nèi)生長發(fā)育上差異無統(tǒng)計學意義(X2為1.614，P0.05)。 8試管嬰兒組新生兒呼吸窘迫綜合征(NRDS)、新生兒高膽紅素血癥的患病率均顯著高于自然受孕組,分別為9.8%(26/264)和4.7%(12/256)，22.3%(59/264)和14.1%(36/256),差異上均有統(tǒng)計學意義(X2分別為5.111和5.976，P0.05)。試管嬰兒組先天畸形發(fā)生率為9.8(26/264)，自然受孕組為5.1%(13/256)，兩者差異上有統(tǒng)計學意義(X2為4.263，P0.05)。 9試管嬰兒組肺出血、呼吸暫停、低血糖的發(fā)生率依次為3.8%(10/264)、12.5%(33/264)、13.6%(36/264)，自然受孕組分別為3.1%(8/256)、9.4%(24/256)、9.8%(25/256)，前者均高于后者，但是差異無統(tǒng)計學意義(P0.05)；在肺炎、電解質(zhì)異常（低鈉血癥、低鈣血癥、低鉀血癥）方面自然受孕組發(fā)生率稍高于試管嬰兒組，分別為19.5%(50/256)和17.0%(45/264)、13.7%(35/256)和11.4%(30/264)，差異并無統(tǒng)計學意義(P0.05)。 結(jié)論： 1試管嬰兒的多胎率、剖宮產(chǎn)率、早產(chǎn)率明顯高于自然受孕組。 2試管嬰兒母親妊高癥和糖尿病發(fā)生率及年齡均顯著高于自然受孕組、這些因素會不同程度的影響新生兒的生存質(zhì)量。 3由于試管嬰兒的特殊性，一些新生兒的并發(fā)癥也隨之出現(xiàn)，本研究顯示，試管嬰兒組新生兒RDS、新生兒高膽紅素血癥、先天畸形發(fā)生率顯著高于自然受孕組，但在肺炎、肺出血、呼吸暫停、血糖及電解質(zhì)異常方面無明顯差別。 4試管嬰兒組在宮內(nèi)生長發(fā)育上與自然受孕組無差別。 5減少試管嬰兒的多胎妊娠，密切監(jiān)測多胎妊娠的圍產(chǎn)期并發(fā)癥，降低早產(chǎn)是提高試管嬰兒新生兒存活率和生存質(zhì)量的關(guān)鍵。
[Abstract]:Objective : To evaluate the safety and feasibility of assisted reproduction technology ( ART ) and provide guidance for the clinical treatment of infants born after IVF - ET .

Methods : 264 cases of live births attended by 178 mothers of IVF - ET in the Second Hospital of Hebei Medical University between January 2011 and December 2013 were studied .
A total of 256 live births attended by two groups of mothers were compared between the two groups . The results were analyzed by SPSS 13.0 software . The results showed that there were no statistical differences between the two groups .

Results :

The pregnancy rate was 48.3 % ( 86 / 178 ) in the test tube group and 6.2 % ( 15 / 241 ) in the natural pregnancy group ( X2 = 99.145 , P0.05 ) .
The preterm birth rate of the test tube group was 40.4 % ( 72 / 178 ) , and the preterm birth rate was 19.5 % ( 47 / 241 ) . There was significant difference between the two groups ( X2 = 22.092 , P0.05 ) .

The average age of mother ' s mother was 33.53 鹵 4.69 years old , the average age of mother was 27.76 鹵 3.93 years , there was significant difference between the two groups ( t = 13.337 , P0.05 ) .
The cesarean section rate was 81.5 % ( 145 / 178 ) in the test tube group and 51.0 % ( 123 / 241 ) in the natural pregnancy group . There was significant difference between the two groups ( X2 = 41.111 , P0.05 ) .

In pregnant women with gestational diabetes mellitus and pregnancy induced hypertension ( PIH ) , the incidence of gestational diabetes was 9.0 % ( 16 / 178 ) and 4.1 % ( 10 / 241 ) in the natural pregnancy group ( X2 = 4.120 , P0.05 ) .
The incidence of pregnancy - induced hypertension in test tube group was 25 . 8 % ( 46 / 178 ) and 14.5 % ( 35 / 241 ) in the natural pregnancy group , and the difference was statistically significant ( X2 = 8.413 , P0.05 ) .

4 . 5 % ( 8 / 178 ) of the placental abnormality in the test tube infants , 18.0 % ( 32 / 178 ) of the umbilical cord abnormality , 14.0 % ( 25 / 178 ) of the premature rupture of the membranes , and 8.7 % ( 21 / 241 ) of the premature rupture of the membranes . There was no statistical difference between the two groups in the placenta , umbilical cord and fetal membranes ( P0.05 ) .

The incidence of intrauterine distress was 6.7 % ( 12 / 178 ) and 3.3 % ( 8 / 241 ) .
There were 10 . 6 % ( 28 / 264 ) asphyxia in the test tube group and 7.8 % ( 20 / 256 ) in the natural pregnancy group . There was no significant difference between the two groups ( P0.05 ) .

There were 43.2 % ( 114 / 264 ) in the infant group after birth and 31.6 % ( 81 / 256 ) in the natural pregnancy group ( X2 = 7.386 , P0.05 ) .

7 . In the aspect of intrauterine growth , the test tube group was less than the gestational age ( 8.3 % ) ( 22 / 264 ) , which was suitable for gestational age ( 85.6 % ) ( 226 / 264 ) , which was more than 6.1 % ( 16 / 264 ) of gestational age , and the natural pregnancy group accounted for 7.8 % ( 20 / 256 ) , 83.2 % ( 213 / 256 ) and 9.0 % ( 23 / 256 ) respectively . There was no significant difference in the growth and development of the two groups ( X2 = 1.614 , P0.05 ) .

The prevalence rates of neonatal respiratory distress syndrome ( NRDS ) and neonatal hyperbilirubinaemia were significantly higher than those in the natural pregnancy group ( 9 . 8 % ( 26 / 264 ) and 4.7 % ( 12 / 256 ) , 22.3 % ( 59 / 264 ) and 14.1 % ( 36 / 256 ) , respectively . The incidence of congenital malformations in the test tube group was 9.8 ( 26 / 264 ) and 5.1 % ( 13 / 256 ) , respectively . There was a significant difference between the two groups ( X2 = 4.263 , P0.05 ) .

9 . The incidence of pulmonary hemorrhage , apnea , hypoglycemia was 3.8 % ( 10 / 264 ) , 12.5 % ( 33 / 264 ) , 13.6 % ( 36 / 264 ) in the test tube group , and 3.1 % ( 8 / 256 ) , 9.4 % ( 24 / 256 ) and 9.8 % ( 25 / 256 ) respectively .
The incidence of natural pregnancy group was slightly higher in pneumonia , electrolyte abnormality ( hypsomia , hypocalcemia , hypokalaemia ) than that in the test group , respectively 19.5 % ( 50 / 256 ) and 17.0 % ( 45 / 264 ) , 13.7 % ( 35 / 256 ) and 11.4 % ( 30 / 264 ) , respectively , and there was no statistical significance ( P0.05 ) .

Conclusion :

The fetal rate , cesarean section rate and preterm birth rate of the test tube infants were significantly higher than those of the natural pregnancy group .

The incidence and age of pregnancy - induced hypertension and diabetes in test - tube infants were significantly higher than those in the natural pregnancy group . These factors influence the quality of life of the newborn .

3 Due to the particularity of the test tube infants , the complications of some newborns also appeared . This study shows that the incidence of RDS , neonatal hyperbilirubinaemia and congenital malformations in the test tube infants group is significantly higher than that of the natural pregnancy group , but there is no significant difference in pneumonia , pulmonary hemorrhage , apnea , blood sugar and electrolyte abnormalities .

There was no difference in the growth and development of the test tube baby group compared with that of the natural pregnancy group .

5 Reduction of fetal pregnancy in test tube infants , closely monitoring the perinatal complications of multiple pregnancy , reducing preterm birth is the key to improve the survival rate and quality of life of newborn infants .

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.8

【引證文獻】

相關(guān)期刊論文 前1條

1 鄧亮亮;魏冬怡;鄭素端;闕文清;黃麗秋;;雙胎早產(chǎn)試管嬰兒的臨床護理探析[J];世界最新醫(yī)學信息文摘;2015年67期

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