早产时应用保留胎膜囊剖宫产术式的临床研究

Clinical research of En caule section in preterm labor

目的 为减少早产儿剖宫产时的损伤。方法 采用EnCaule剖宫产术式用于早产儿剖宫产 ,共 2 6例 ,其中孕2 9～ 31w末 3例 ,孕 32～ 34w末 18例 ,孕 35～ 36w末 15例。并在孕周≤ 34w末时 ,对EnCaule剖宫产术和子宫下段剖宫产术式进行比较。结果 36例行EnCaule剖宫产术成功 2 5例 ,未成功 11例 ,成功率为 6 9.4 4 % ,两者在羊水量、出生体重及孕周皆有显著差异 (P <0 .0 5 ) ,在羊水量 >10 0 0ml,出生体重 >2 0 0 0g ,孕周 >34w时手术成功率较低。对孕周≤ 34w时 19例EnCaule剖宫产术与 15例子宫下段剖宫产术进行比较 ,从麻醉开始到胎儿娩出时间、羊水量、出生体重无显著差异 (P >0 .0 5 ) ,Apgar评分 (1min和 5min评分 )无显著差异 (P >0 .0 5 ) ,但EnCaule剖宫产术 5例发生窒息 ,窒息发生率为 2 6 .32 % ,皆为轻度窒息 ;子宫下段剖宫产术 8例发生窒息 ,窒息发生率为 5 3.33% ,其中 5例轻度窒息 ,3例重度窒息 ,两者差异显著 (P<0 .0 5 )。结论 对孕周小的低体重儿特别是极低体重儿 ,EnCaule剖宫产手术成功率高 ,并能减少对胎儿的损伤。

Objective: To decrease the injury to the premature neonatal in cesarean section. Methods: En Caule cesarean section were performed in 36 cases of preterm labor. Among them, 3 are between 29 and 31 gestational weeks, 18 are between 32 and 34 gestational weeks and 15 are between 35 and 36 gestational weeks. En Caule CS was compared with low segment CS when gestational age s less than 35 week. Results: Among 36 cases of En Caule CS, 25 cases succeeded and 11 cases failed. The successful rate is 69.44%. There are significant differences between the successful cases and the failed cases in the amount of amniotic fluid, the body weight and gestational age of neonatals(P<0.05). When the amniotic fluid is less than 1000ml, the newborn body weight is more than 2000g and the gestational age is more than 34 weeks, the sussessful rate is low. 19 cases of En Caule CS performed on the patients whose gestational ages are less than 34 week are compared with 15 cases of low segment CS. There are no significant differences between them in the duration from anesthetic onset to fetal delivery, the amount of amniotic fluid, the newborn body weight and Apgar score(1min and 5min)(P<0.05). However,for En Caule CS, neonatal asphyxia occurred in 5 cases. All of them are mild asphyxia. The incidence is 26.32%. For low segment CS neonatal asphyxia occurred in 8 cases, among which 5 are mild asphyxia and 3 are severe asphyxia. The incidence is 53.33%. The difference between En Caule CS and low segment CS is significant(P<0.05). Conclusion: For preterm labor low-bith weight infant,especially very-low-weight neonatals, the En Caule CS tends to succeed and can reduce the neonatal morbidity.