發(fā)布時(shí)間：2018-07-18 08:27

【摘要】：目的： 研究妊娠期生殖道感染的特征，探討生殖道感染及其干預(yù)措施與孕產(chǎn)婦圍產(chǎn)結(jié)局的關(guān)系，為妊娠期生殖道感染的防治提供依據(jù)，提高新生兒出生質(zhì)量。 方法： 選取2012年3月～2013年2月鹽城市婦幼保健院婦產(chǎn)科接診的孕6-36周的妊娠期婦女進(jìn)行細(xì)菌、假絲酵母菌、滴蟲、衣原體、支原體、淋球菌等生殖道感染性疾病的檢查。應(yīng)用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析，分析不同孕周、不同年齡孕婦之間生殖道感染的類型及分布特征。結(jié)合孕婦孕周及自主要求將孕婦分為治療組和非治療組，治療者根據(jù)檢查結(jié)果針對(duì)性的進(jìn)行抗感染治療，記錄干預(yù)治療措施及治療效果與安全性，非治療組不予以處理。跟蹤所有入選孕婦的圍產(chǎn)結(jié)局，探討分析生殖道感染、不同感染類型、不同干預(yù)措施與圍產(chǎn)結(jié)局之間的關(guān)系。 結(jié)果： 1.生殖道感染特征 本研究中共1863例孕婦接受生殖道感染性疾病的檢查。檢查結(jié)果得出，未感染者1078例，占57.86%，存在生殖道感染者共785例，占42.14%。感染組和未感染組在年齡、孕次、流產(chǎn)次數(shù)方面的比較均無(wú)顯著差異，無(wú)統(tǒng)計(jì)學(xué)意義。細(xì)菌性陰道病、滴蟲、支原體、衣原體、假絲酵母菌、淋球菌、β-溶血性鏈球菌感染的發(fā)生機(jī)率分別為11%、2.31%、8.91%、4.03%、9.34%、1.45%、5.10%。感染者中感染類型分布如下：細(xì)菌性陰道病、滴蟲、支原體、衣原體、假絲酵母菌、淋球菌、β-溶血性鏈球菌感染的例數(shù)分別為205（26.11%）、43（5.48%）、166（21.15%）、75（9.55%）、174（22.17%）、27（3.44%）、95（12.10%）。 2.不同孕期生殖道感染分布特征 孕早期感染者297例，占37.83%；孕中期感染者250例，占31.85%；孕晚期238例，占30.32%。孕早期感染以細(xì)菌性陰道病、假絲酵母菌及支原體感染為主；細(xì)菌性陰道病感染在各孕期感染中占比最高；β-溶血性鏈球菌感染主要出現(xiàn)在孕晚期。 3.干預(yù)措施及療效 本研究中785例感染者采取治療者439例（治療組），未采取治療者346例（非治療組）。治療組中，孕早期151例，占感染者的19.24%；孕中期146例，占18.60%；孕晚期142例，占18.09%。非治療組中，孕早期146例，占18.60%；孕中期104例，占13.25%；孕晚期96例，占12.23%。治療組與非治療組在各孕期的分布方面無(wú)顯著差異，具有可比性。治療組中細(xì)菌感染者112例，滴蟲性陰道炎25例，支原體感染者85例，衣原體感染者29例，外陰陰道假絲酵母菌166例，淋球菌22例。兩組在生殖道感染類型方面也無(wú)顯著性差異，，具有可比性。治療組經(jīng)過針對(duì)性的精心治療后，治愈209例（47.61%），顯效157例（35.76%），有效52例（11.85%），無(wú)效21例（4.78%），總的治療有效率（治愈率+顯效率）為83.37%。 4.圍產(chǎn)結(jié)局 本組1863例研究病例中，共有562例出現(xiàn)不良圍產(chǎn)結(jié)局。按感染特征分類，261例出現(xiàn)在未感染組，不良結(jié)局的發(fā)生機(jī)率為24.21%（261/1078），301例出現(xiàn)在感染組，發(fā)生機(jī)率為38.34%（301/785），感染組不良結(jié)局的發(fā)生率顯著高于未感染組，兩者具有統(tǒng)計(jì)學(xué)差異（X2=43.065，P0.05）；按感染組孕產(chǎn)婦是否采取干預(yù)措施分類，治療組132例出現(xiàn)不良圍產(chǎn)結(jié)局，發(fā)生機(jī)率為30.07%（132/439），非治療組169例出現(xiàn)不良圍產(chǎn)結(jié)局，發(fā)生機(jī)率為48.84%（169/346），治療組不良圍產(chǎn)結(jié)局的發(fā)生率顯著低于非治療組，差異具有統(tǒng)計(jì)學(xué)意義（X2=28.853，P0.05）。 結(jié)論： 1.妊娠期生殖道感染性疾病的感染率為42.14%，其中細(xì)菌性感染的發(fā)生率最高，達(dá)26.11%。 2.感染組和未感染組在年齡、孕次、流產(chǎn)次數(shù)方面的比較均無(wú)顯著差異。 3.妊娠期生殖道感染可發(fā)生在各個(gè)孕期，各孕期總的感染率無(wú)差異，但生殖道感染的類型有所不同，孕早期感染以細(xì)菌性陰道病、假絲酵母菌感染及支原體感染為主，細(xì)菌性陰道病感染在各孕期感染中占比最高，β-溶血性鏈球菌感染主要出現(xiàn)在孕晚期。 4.妊娠期生殖道感染可得到良好的治療效果，總的治療有效率為83.37%。 5.妊娠期不良結(jié)局的發(fā)生機(jī)率為30.17%。 6.妊娠期生殖道感染者發(fā)生不良結(jié)局的機(jī)率（38.34%）顯著高于未感染者（24.21%）。 7.妊娠期生殖道感染采取干預(yù)措施者發(fā)生不良結(jié)局的機(jī)率（30.07%）顯著低于未采取干預(yù)措施者（48.84%）。
[Abstract]:Purpose :

To study the characteristics of genital tract infection during pregnancy , to explore the relationship between genital tract infection and its intervention measures and perinatal outcome , and to provide the basis for prevention and treatment of reproductive tract infection during pregnancy , and to improve the birth quality of the newborn .

Method :

The types and distribution of reproductive tract infections among pregnant women with different gestational weeks and different ages were analyzed by SPSS 17.0 . The perinatal outcomes of all selected pregnant women were analyzed . The relationship between reproductive tract infection , different types of infection , different intervention measures and perinatal outcomes was discussed .

Results :

1 . Reproductive tract infection characteristics

The incidence of bacterial vaginopathy , trichomonad , mycoplasma , chlamydia , Candida albicans , gonococcus , 尾 - hemolytic streptococcus infection were found to be 205 ( 26.11 % ) , 43 ( 5.48 % ) , 166 ( 21.15 % ) , 75 ( 9.55 % ) , 174 ( 22.17 % ) , 27 ( 3.44 % ) , 95 ( 12.10 % ) respectively .

2 . Distribution characteristics of reproductive tract infection in different pregnancy stages

297 cases were infected with early pregnancy , accounting for 37.83 % ;
In the mid trimester of pregnancy , 250 cases were infected , accounting for 31.85 % ;
238 cases in the late pregnancy ( 30.32 % ) were infected with bacterial vaginopathy , Candida albicans and mycoplasma infection .
The infection rate of bacterial vaginopathy is the highest in each pregnancy infection .
The infection of 尾 - hemolytic streptococcus is mainly in the late pregnancy .

3 . Intervention measures and efficacy

Among the 785 cases in the study , 439 cases ( treatment group ) were treated , 346 cases were not treated ( non - treatment group ) . In the treatment group , 151 cases were early pregnancy , accounting for 19.24 % of the infected persons ;
There were 146 cases in the middle of pregnancy , accounting for 18.60 % ;
There were 142 cases ( 18.09 % ) in the late pregnancy , 146 in the non - treatment group ( 18.60 % ) .
104 cases ( 13.25 % ) were pregnant .
In the treatment group , there were 112 cases of bacterial infection , 25 cases of trichomonas vaginitis , 85 cases of mycoplasma infection , 29 cases of chlamydia infection , 166 cases of vulvovaginal candida , and 22 cases of gonococcus .

4 . perinatal outcome

The incidence of adverse outcomes was 24.21 % ( 261 / 1078 ) , 301 in the infection group and 38.34 % ( 301 / 785 ) in the infection group . The incidence of adverse outcomes was significantly higher in the infection group than in the uninfected group ( X2 = 43.65 , P0.05 ) .
The incidence of adverse perinatal outcome in 132 cases of treatment group was 30.07 % ( 132 / 439 ) . The incidence of adverse perinatal outcome was 48.84 % ( 169 / 346 ) . The incidence of adverse perinatal outcome in treatment group was significantly lower than that in non - treatment group ( X2 = 28.853 , P0.05 ) .

Conclusion :

1 . The infection rate of reproductive tract infectious diseases during pregnancy was 42.14 % , among which the incidence of bacterial infection was the highest , reaching 26.11 % .

2 . There was no significant difference between the infection group and the non - infected group in the age , pregnancy and the number of abortions .

3 . During pregnancy , reproductive tract infection can take place during pregnancy . There is no difference in the overall infection rate during pregnancy , but the type of genital tract infection is different . The infection with bacterial vaginopathy , Candida albicans infection and mycoplasma infection is the main infection in the early pregnancy , and the infection of bacterial vaginopathy is the highest in each pregnancy infection , and the infection of 尾 - hemolytic streptococcus is mainly in the late pregnancy .

4 . During pregnancy , reproductive tract infection can get a good therapeutic effect , and the total effective rate is 83.37 % .

5 . The incidence of adverse outcome in pregnancy was 30.17 % .

6 . The probability of adverse outcomes ( 38.34 % ) of patients with reproductive tract infection during pregnancy was significantly higher than that of non - infected persons ( 24.21 % ) .

7 . The probability of adverse outcomes ( 30.07 % ) in patients with reproductive tract infections during pregnancy was significantly lower than those without intervention ( 48.84 % ) .
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.7

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