早产胎膜早破78例结局临床分析

Clinical Analysis of the Outcome of 78 Cases of Patents with Premature Labor Complicated with Premature Rupture of Membranes

目的:探讨早产胎膜早破的临床处理方法及结局。方法:回顾性分析78例早产胎膜早破(PPROM)患者,对孕周<35周患者进行保胎并应用抗生素预防感染治疗,其中<34周者给予地塞米松5mg肌注,2次/d促胎肺成熟。对于孕周≥35周者不予保胎。结果:孕周>34周者围产儿死亡率达6.4%,<34周者围产儿死亡率高达27.0%,两者有显著性差异(P<0.01)。新生儿窒息率孕周<34周者为43.2%,>34者为12.7%,两组比较差异有显著性(P<0.05)。新生儿RDS<34孕周者为37.8%,>34孕周者为0%,两者差异有显著性(P<0.01)。结论:对于早产胎膜早破(PPROM)>35周应实行期待治疗,<34周应用皮质激素促胎肺成熟。在保胎过程中需密切观察孕妇的体温、脉搏、白细胞总数、血C-反应蛋白、胎心变化、羊水性状及子宫压痛等,适时选择适当方式终止妊娠。

Objective： To explore clinical treatments and outcome of the patients with premature labor complicated with premature rupture of membranes. Methods： A total of 78 cases of patients with PPROM （premature labor complicated with premature rupture of membranes） admitted in our hospital from January 2002 to August 2008 were performed with retrospective analysis. Patients with gestational weeks less than 35 weeks were treated with tocolysis treatment and antibiotics were used for infection prevention, and the patients with gestational weeks less than 34 weeks were given 5mg of dexamethasone through intramuscular injection twice a day so as to promote the maturity of foetus lung; while those patients with gestational weeks more than 35 weeks were treated with no tocolysis treatment. Results：Perinatal mortality rate of the patients with gestational weeks more than 34 weeks reached 6.4%, while perinatal mortality rate of the pa- tients with gestational weeks less than 34 weeks reached as high as 27.0%, and significant difference was obtained between them （P〈0.01）. Asphyxia neonatorum rate of the patients with gestational weeks less than 34 weeks was 43.2%, while asphyxia neonatorum rate of the patients with gestational weeks more than 34 weeks was 12.7%, and significant difference was obtained between them （P〈0.05）. Newborn infant RDS of the patients with gestational weeks less than 34 weeks was 37.8%, while newborn infant RDS of the pa- tients with gestational weeks more than 34 weeks was 0%, and significant difference was obtained between them （P〈0.01）. Conclusions：The patients with PPROM more than 35 weeks should be treated with expectant treatment, while those patients with PPROM less than 34 weeks should be treated with corticosteroids to promote the promote the maturity of foetus lung. During the process of tocolysis treatment, body tempera- ture, pulse, total white blood ceils, blood C-reactive protein, fetal heart variation, amniotic fluid character and uterus tenderness etc. of the pregnant women should be observed closely, and appropriate methods could be used for termination of pregnancy.