發(fā)布時間：2018-05-07 00:15

  本文選題：胎兒 + 先天畸形��； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:調查2011-2015年長治市某三甲醫(yī)院胎兒先天畸形(congenital malformation,CM)的患病情況;闡明超聲學產(chǎn)前篩查的必要性;對引起胎兒CM的主要危險因素展開分析,從而在孕前的咨詢、保健等方面提供可靠依據(jù)。方法:對長治市某三甲醫(yī)院2011-2015年的胎兒CM情況進行登記。2011年~2015年醫(yī)院終止妊娠產(chǎn)婦(包括正常生產(chǎn)和其他原因的終止妊娠)是9783例,其中胎兒CM是245例。胎兒CM類型按照國際疾病編碼(ICD10)進行歸類,分析長治市某三甲醫(yī)院近五年來胎兒CM的現(xiàn)狀及特征,以及超聲顯像技術診斷胎兒CM的基本情況。采用1:2病例對照研究,選取病例組114例,對照組228例,調查產(chǎn)婦的基本信息,包括:孕婦年齡、文化程度、居住地區(qū)、孕期是否上感,孕期是否有微生物感染(血清弓形蟲、巨細胞病毒、單純皰疹病毒及風疹病毒感染)、服藥史、工作環(huán)境、有害物質接觸(包括工業(yè)毒物、農(nóng)藥、吸煙、飲酒等)、是否服用葉酸、異常生育史、家族史、近親婚配史,嚴格篩選胎兒CM的影響因素,通過多因素logistic回歸分析來計算這些危險因素的比值比(OR值)。結果:1.長治市某三甲醫(yī)院2011-2015年胎兒CM現(xiàn)狀分析1)終止妊娠的孕婦9783例,胎兒CM 245例,胎兒CM率2.50%;經(jīng)統(tǒng)計學分析,5年間在此醫(yī)院胎兒CM的發(fā)生率差異比較無統(tǒng)計學意義(X~2=2.116,P=0.191)。2)按照國際疾病分類的系統(tǒng)分類法,胎兒CM排在前五位的依次是中樞神經(jīng)系統(tǒng)(36.73%)、頭面部(18.38%)、心血管系統(tǒng)(16.73%)、骨骼肌肉系統(tǒng)(8.98%)、泌尿生殖系統(tǒng)(6.53%)。按照發(fā)生部位分類,胎兒cm排在前5位的分別是是先心病(16.7%)、脊柱裂(12.2%)、腦積水(12.2%)、唇腭裂(11.8%)、無腦畸形(6.5%)。3)男女胎兒cm的發(fā)生率分別為2.38%和2.68%;胎兒cm男女性別發(fā)生率之比為0.89:1,胎兒cm在性別之間的差異無統(tǒng)計學意義(X~2=0.881,p=0.348);4)城鎮(zhèn)和農(nóng)村胎兒cm的發(fā)生率分別為1.62%和3.51%,胎兒cm在城鄉(xiāng)間的差異有統(tǒng)計學意義(X~2=55.730,p(27)0.05);5)母親年齡在25歲、25歲-29歲、30歲-34歲、"g35歲的胎兒cm發(fā)生率分別為為2.61%,1.90%,5.43%,7.90%,各年齡組之間胎兒cm發(fā)生率差異有統(tǒng)計學意義(X~2=66.033,p(27)0.05)。25-29歲年齡段是胎兒cm的低發(fā)年齡,≥35年齡段是胎兒cm高發(fā)年齡。6)小學及小學以下產(chǎn)婦所生胎兒cm發(fā)生率為5.73%,不同文化程度產(chǎn)婦所生產(chǎn)胎兒cm發(fā)生率之間差異有統(tǒng)計學意義(X~2=18.421,p(27)0.05)。7)從確診時間上來看,在245例胎兒cm兒中,產(chǎn)前確診167例,占68.16%;產(chǎn)后確診78例,占31.84%,產(chǎn)前診斷的比例由2011年的52.63%增加至2015年的75.81%。8)從胎兒cm確診依據(jù)上來看,2011年至2015年產(chǎn)前超聲檢查胎兒cm的檢出率為2.10%(194/9219)。在由超聲診斷的畸形兒中,在28周前超聲檢出的畸形兒比例由2011年的35%增加至2015年的63.64%。2.胎兒cm的1:2病例對照研究展開對比分析,得出以下結果:引起胎兒畸形的危險因素主要有:孕期感冒發(fā)熱(or=2.163,95%ci:1.025-4.563)、病毒感染(0r=3.285,95%ci:1.146-9.411)、孕期服用藥物(or=2.603,95%ci:1.061-6.386)、孕期接觸有害物質(or=6.264,95%ci:2.211-7.755)、不良孕產(chǎn)史(or=1.97,95%ci:1.058-3.667)、居住農(nóng)村地區(qū)(or=2.526,95%ci:1.498-4.26)、丈夫喝酒(or=2.195,95%ci:1.052-4.582)、吸煙(or=2.017,95%ci:1.067-3.811),而增補葉酸(or=0.324,95%ci:0.136-0.772)為保護性因素。結論:2011-2015年長治市某三甲醫(yī)院胎兒cm發(fā)生率2.50%;按照發(fā)生部位胎兒cm前5位的分別是先心病、脊柱裂、腦積水、唇腭裂、無腦畸形。產(chǎn)前超聲檢查對胎兒畸形檢出率為2.10%,在28周前由超聲診斷出的胎兒cm占據(jù)了越來越高的比例,也就是說,接受產(chǎn)前超聲診斷的孕婦越來越多。孕期感冒發(fā)熱、丈夫喝酒、吸煙等是胎兒CM發(fā)生的高危因素。盡快為孕婦補充葉酸,增強孕期保健質量,積極開展產(chǎn)前篩查,通過及早診斷從而盡可能減少CM出生。
[Abstract]:Objective: To investigate the prevalence of congenital malformation (congenital, CM) in a three a hospital in Changzhi, to clarify the necessity of prenatal screening for ultrasound, and to analyze the major risk factors for fetal CM, so as to provide a reliable basis for pre pregnancy counseling and health care. Method: 2011 The status of fetal CM in -2015 years was registered in.2011 ~2015 years (including normal production and other reasons for termination of pregnancy) in 9783 cases, of which the fetal CM was 245. The fetal CM type was classified according to the international disease code (ICD10), and the status and characteristics of fetal CM in a three a hospital of Changzhi in the last five years were analyzed, as well as over the past five years. The basic information of acoustic imaging in the diagnosis of fetal CM was carried out. A case control study of 1:2 was used to select 114 cases of case group and 228 cases in the control group. The basic information of pregnant women was investigated, including the age of the pregnant women, the degree of education, the area of residence, the feeling of pregnancy, and the infection of the pregnant women (serum Toxoplasma, cytomegalovirus, herpes simplex virus and rubella). Drug history, working environment, hazardous material contact (including industrial poison, pesticide, smoking, drinking, etc.), whether to use folic acid, abnormal birth history, family history, marriage history of close relatives, select the factors of fetal CM, and calculate the ratio Ratio of these risk factors through multiple factor Logistic regression analysis (OR value). Results: 1. Changzhi City The analysis of the status of fetal CM in 2011-2015 years of the third one hospital 1) 9783 cases of pregnant women terminating pregnancy, 245 fetal CM, and 2.50% fetal CM rate. By statistical analysis, there was no statistically significant difference in the incidence of fetal CM in this hospital between 5 years (X~2=2.116, P=0.191).2) according to the systematic classification of international disease classification, the first five fetus CM rows were in the middle The armature nervous system (36.73%), the head and face (18.38%), the cardiovascular system (16.73%), the skeletal muscle system (8.98%) and the genitourinary system (6.53%). According to the location of the site, the first 5 of the fetal cm rows are the congenital heart disease (16.7%), the spina bifida (12.2%), the hydrocephalus (12.2%), the cleft lip and palate (11.8%), and the acerebral (6.5%).3) and the incidence of cm in the fetus and the fetus. Do not be 2.38% and 2.68%; the ratio of male and female sex in fetal cm was 0.89:1, and there was no statistically significant difference between the sex of fetal cm (X~2=0.881, p=0.348); 4) the incidence of cm in urban and rural foetus was 1.62% and 3.51% respectively, and the difference between fetal cm in urban and rural areas was statistically significant (X~2=55.730, P (27) 0.05); 5) mothers were 25 years old and 25 years old in 25 years. 30 years old -34 years old, "the incidence of fetal cm at G35 years old is 2.61%, 1.90%, 5.43%, 7.90% respectively, and there is a significant difference in the incidence of fetal cm (X~2=66.033, P (27) 0.05).25-29 age age is the low onset age of fetal cm, and the age of 35 is the high incidence of fetal cm.6) the incidence of cm in primary and primary schools is 5.73. The difference in the incidence of fetal cm produced by pregnant women at different educational levels was statistically significant (X~2=18.421, P (27) 0.05).7) from the time of diagnosis, 167 cases were diagnosed in 245 fetal cm children, 68.16% were prenatal, 78 were diagnosed postpartum, 31.84% were diagnosed, and the proportion of prenatal diagnosis was increased from 52.63% in 2011 to 75.81%.8 in 2015) from fetal cm. From 2011 to 2015, the detection rate of fetal cm was 2.10% (194/9219). In ultrasound diagnosed malformed children, the ratio of abnormal children detected by ultrasound 28 weeks ago from 35% in 2011 to 1:2 case control study of 63.64%.2. fetal cm in 2015 was compared and analyzed, and the following results were obtained: fetal malformation The main risk factors are: pregnancy cold and fever (or=2.163,95%ci:1.025-4.563), virus infection (0r=3.285,95%ci:1.146-9.411), pregnancy drug (or=2.603,95%ci:1.061-6.386), pregnancy exposure to harmful substances (or=6.264,95%ci:2.211-7.755), bad pregnancy history (or=1.97,95%ci:1.058-3.667), living in rural areas (or=2.526,95%ci:1.498-4.2) 6) husband drinking (or=2.195,95%ci:1.052-4.582), smoking (or=2.017,95%ci:1.067-3.811), and supplementation of folic acid (or=0.324,95%ci:0.136-0.772) as a protective factor. Conclusion: the incidence of cm in fetal cm in a three a hospital in Changzhi was 2.50%. The first 5 of the fetus cm were congenital heart disease, spina bifida, hydrocephalus, cleft lip and palate, and no brain. Abnormality. The rate of prenatal ultrasound detection of fetal malformation is 2.10%, and the ratio of fetal cm diagnosed by ultrasound 28 weeks ago is higher and higher, that is to say, more and more pregnant women are diagnosed with prenatal ultrasound. The high risk factors of fetal CM hair are cold and fever during pregnancy, husband drinking, smoking and so on. In order to reduce the CM birth rate, we should carry out prenatal screening actively and diagnose early.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.5;R197.32

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