未足月胎膜早破期待疗法的效果评价及注意事项探讨

The Discussion of Effectiveness and Announcements about Preterm Premature Rupture of the Membranes with Expectant Treatment

目的观察未足月胎膜早破期待疗法的临床效果,探讨其可行性及注意事项。方法2006年1月至2008年12月在肇庆市端州区红十字会医院分娩未足月胎膜早破150例,其中破膜后出现规律宫缩,宫口≥3cm,早产已不可避免,以及孕妇及家属要求而终止妊娠共42例作为对照组,其余108例作为观察组进行期待疗法:静脉滴注25%硫酸镁30～50mL/d或硫酸沙丁胺醇2.4～4.8mgpo,tid,持续3～5d以抑制宫缩疗;肌内注射地塞米松5mg,2次/d,每周2d促胎肺成熟;青霉索或头孢菌素;预防感染。结果观察组产后出血少、孕周延长、产褥感染少、新生儿体质量增加、Apgar改善、RDS及死亡下降,与对照组比较有显著差异(P<0.05)。结论对pPROM进行包括抑制宫缩、促进胎肺成熟、预防感染的期待治疗具有可行性,实施中应该注意与患者进行充分沟通,以获得理解,积极配合治疗;结合临床综合选择分娩方考虑,应尽量避免阴道助产手术,有产科指征或母婴有感染征象时,应选择剖宫产为宜。

Objective To observe the clinical effectiveness preterm premature rupture of the membranes with expectant treatment, and to explore the feasibility and notes. Method From January 2006 to December 2008 deliveries in our hospital 150 cases of preterm premature rupture of the membranes, after which the law of uterine rupture, Miyagnchi ≥ 3cm, prematurity has been inevitable, as well as pregnant women and their families request termination of pregnancy A total of 42 cases as a Control group, and the remaining 108 cases to look forward to as the observation group therapy： 25 percent of intravenous magnesium sulfate 30～50mL/d or salbutamol 2.4～4.8mg po, rid, continuing to contain 3～5d treatment contraction; intramuscular dexamethasone 5mg, 2 times/d, a week to promote fetal lung maturity 2d, Penicillium cable or cephalosporins; the prevention of infection. Result Small group of postpartum hemorrhage, gestational age extended less puerperal infection, neonatal weight gain, Apgar improvement, RDS and mortality decline, compared with the control group were significantly different （P〈0.05）. Conclusion pPROM including inhibition of contraction, the promotion of fetal lung maturity, the expectations of the treatment of prevention of infection with the feasibility of implementation should pay attention to fully communicate with patients in order to obtain onderstanding, actively cooperate with the treatment; integrated clinical delivery options to consider should be vaginal birth to avoid surgery, there are obstetric indications or signs of maternal infection, cesarean section should be chosen appropriate.