发生早产的影响因素及其预后的相关研究

The study of the cause factors of premature and the prognisis of premature

目的 探讨早产的主要因素和并发症对早产儿的影响。方法 回顾性分析2001年12月-2002年12月出生的356例（10．8％）早产儿，将其分为阴式分娩组和剖宫产组，对不同原因所致早产儿的预后作统计学分析，并比较产式对其的影响。结果①胎膜早破127例，占35．67％，是引起早产的主要原因；胎膜早破组新生儿窒息的发生率为27．81％，而未破膜组为12．45％，两者比较有显著性差异（x^2=8．152，P〈0．05）；②胎龄越小死亡率越高，死亡的5例早产儿平均孕龄为28．5周；③56例早产儿中发生合并症的有266例，占74．72％，居前四位的分别为：新生儿高胆红素血症71例，占19．94％；新生儿贫血67例，占18．82％；新生儿肺炎30例，占8．43％；新生儿窒息29例，占8．14％；④入住重症监护室的早产儿共126例，主要病因是窒息、缺氧缺血性脑病、颅内出血及新生儿肺透明膜病。结论 早产是新生儿发病和死亡的主要原因，窒息、颅内出血和多脏器器官功能衰竭是早产儿死亡的主要原因，加强早产儿并发症的预防，提高抢救水平是预后的关键。

Objective To investigate the risk factors, perinatal management of premature delivery and outcomes of premature infants. Methods The medical records of 356 premature infants from Dec. 2001 to Dec. 2002 born in our hospital were reviewed. According to delivery patterns（ the premature infants were divided into two groups： cesarean section group and vaginal delivery group. Results Premature rupture of fetal membranes （PROM） （ 127 cases, 35.67% ） was the major cause of premature delivery. The incidence of neonatal asphyxia in PROM subgroup was 27.81% , while that in no-PROM subgroup was 12.45% , there was a significant difference between the two groups（x^2 = 8. 152, P 〈 0.05 ）. The average gestational age of 5 dead premature infants was 28.5 weeks. The less the gestational age, the higher the mortality. 266/356 （74. 72% ） premature infants had perinatal complications, and the first four complications were neonatal hyperbilirubinemia （71 cases, 19.94% ）, neonatal anemia （67 cases, 18.82% ） , neonatal pneumonia（30 cases, 8.43% ） and neonatal asphyxia（29 cases, 8.14% ）. 126 premature infants admitted to NICU, and the major causes of admission included asphyxia, HIE, intracranial hemorrhage and neonatal pulmonary hyaline membrane disease. Between the vaginal delivery group and cesarean section group, in incidence of intracranial hemorrhage, there was significant difference （ P 〈 0.05 ）. Conclusion Premature delivery is a main cause of neonatal morbidity and mortality, and neonatal asphyxia, intracranial hemorrhage and multiple organ failure （MOF） are major causes of death of the premature infants. Intensifying prevention for perinatal complications of the premature infants and raising the pediatriciar＇ s salvage ability are two crucial steps for better prognosis of premature delivery.