本文選題：足月胎膜早破 + 陰道微生態(tài)��； 參考：《重慶醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:通過分析比較足月胎膜早破和足月未破膜孕婦陰道微生態(tài)以及B族鏈球菌(GBS)感染情況,探究足月胎膜早破陰道微生態(tài)改變以及GBS感染與母兒結(jié)局的關(guān)系。方法:收集2015年01月到2016年03月在重慶醫(yī)科大學(xué)附屬第二醫(yī)院產(chǎn)科住院生產(chǎn)的,足月胎膜早破孕婦74例為tPROM組。隨機(jī)選取同期收治入院的正常足月未破膜孕婦74例為對(duì)照組。比較分析兩組陰道微生態(tài)情況及母兒結(jié)局,將胎膜早破組中74例研究對(duì)象根據(jù)GBS感染情況及陰道微生態(tài)情況分為GBS陽性組、GBS陰性組、微生態(tài)正常組及微生態(tài)失調(diào)組,再分析比較四組的新生兒病理性黃疸、新生兒敗血癥、產(chǎn)褥感染的發(fā)生情況。結(jié)果:1.t PROM組孕婦在陰道微生態(tài)失調(diào)率、陰道pH異常(pH4.5)發(fā)生率、乳桿菌優(yōu)勢(shì)改變率明顯大于對(duì)照組(p0.05),差異有統(tǒng)計(jì)學(xué)意義。2.t PROM組主要優(yōu)勢(shì)菌為G+球菌(39.18%),對(duì)照組主要優(yōu)勢(shì)菌為G+桿菌(52.70%)。3.tPROM組與對(duì)照組孕婦陰道分泌物病原微生物中BV、VVC、BV+VVC的發(fā)生率比較,差異都無統(tǒng)計(jì)學(xué)意義(p0.05)。兩組GBS感染率相比較,兩者的差異具有統(tǒng)計(jì)學(xué)意義(p0.05),其中tPROM組GBS感染為16.22%,對(duì)照組GBS感染為5.41%。4.tPROM組與對(duì)照組新生兒出生后1min、5min Apgar評(píng)分以及新生兒血?dú)鈖H異常的比較,差異不具有統(tǒng)計(jì)學(xué)意義(p0.05),tPROM組新生兒病理性黃疸及產(chǎn)褥感染發(fā)生率高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。5tPROM組中微生態(tài)正常組與失調(diào)組的母兒不良結(jié)局無差異(p0.05)6.tPROM組中GBS陽性組與陰性組新生兒血?dú)鈖 H異常發(fā)生率比較,差異并沒有統(tǒng)計(jì)學(xué)意義(p0.05)。GBS陽性組新生兒病理性黃疸率及產(chǎn)婦產(chǎn)褥感染率都明顯高于GBS陰性組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:足月胎膜早破孕婦陰道微環(huán)境穩(wěn)態(tài)發(fā)生了改變,重點(diǎn)表現(xiàn)在乳桿菌優(yōu)勢(shì)改變、優(yōu)勢(shì)菌由G+桿菌變?yōu)镚+球菌及陰道p H的改變;足月胎膜早破的發(fā)生可能與陰道微環(huán)境的改變、GBS的感染有關(guān)。足月胎膜早破的發(fā)生可能引起新生兒病理性黃疸及產(chǎn)褥感染的不良結(jié)局,而GBS的感染可能在其中發(fā)揮著很大的作用,其不良結(jié)局的發(fā)生與陰道微生態(tài)的失調(diào)關(guān)系不明顯。
[Abstract]:Objective: to compare the vaginal microecology and group B streptococcus infection in pregnant women with term premature rupture of membranes and term unbroken membranes, and to explore the relationship between GBS infection and maternal and fetal outcome. Methods: from January 2015 to March 2016, 74 pregnant women with premature rupture of membranes were enrolled in tPROM group. 74 normal term unbroken pregnant women admitted to hospital at the same time were randomly selected as control group. According to GBS infection and vaginal microecology, 74 cases of premature rupture of membranes were divided into GBS positive group, normal group and microecological disorder group. The incidence of pathological jaundice, neonatal septicemia and puerperal infection in the four groups were analyzed and compared. Results 1. The misadjustment rate of vaginal microecology and pH of vaginal pH abnormality were 4.5% in PROM group. The dominant change rate of Lactobacillus was significantly higher than that of the control group (P 0.05). The difference was statistically significant. The main dominant bacteria in the PROM group was G cocci, and the main dominant bacteria in the control group was the G bacilli 52.70. 3. The incidence of BV VCCV VVC in vaginal secretions of pregnant women in the control group and the control group was significantly higher than that in the control group. The difference was not statistically significant (P 0.05). The difference of GBS infection rate between the two groups was statistically significant (p 0.05). The GBS infection rate in tPROM group was 16.22, and the GBS infection in control group was Apgar score and abnormal blood gas pH at 1 min after birth between 5.41%.4.tPROM group and control group. The incidence of neonatal pathological jaundice and puerperal infection was higher in the group of p0.05 and tPROM than that in the control group. There was no significant difference in maternal and fetal adverse outcomes between microecologically normal group and maladjusted group in p0.05 + .5tPROM group. The incidence of abnormal blood gas pH in GBS positive group and negative group was higher than that in control group. The rate of pathological jaundice and puerperal infection rate of puerpera in the positive group were higher than those in the negative group of GBS, and the difference was statistically significant (P 0.05). Conclusion: the stable state of vaginal microenvironment in pregnant women with premature rupture of term membranes has changed, especially in the changes of Lactobacillus dominant bacteria from G bacillus to G coccus and vaginal pH. The occurrence of term premature rupture of membranes may be related to the change of vaginal microenvironment and the infection of GBS. Premature rupture of full-term membranes may lead to pathological jaundice of newborns and adverse outcome of puerperal infection, and GBS infection may play a great role in it. The relationship between the occurrence of premature rupture of membranes and the imbalance of vaginal microecology is not obvious.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R714.433

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