82例未足月胎膜早破剩余羊水量与围产儿病率的关系研究

Corre1ation between Rresidue amniotic fluid volume after preterm premature rupture of membranes and perinatal morbidity

目的 探讨未足月胎膜早破（PPROM）发生后剩余羊水最与围产儿病率的关系.方法 选择2004年12月-2009年12月韶关市妇幼保健院46例、韶关市第一人民医院36例,共计82例PPROM孕妇.根据胎膜破裂后羊水指数（AFI）将病例分为三组：羊水量正常组（80 mm≤AFI＜180 mm）42例;羊水偏少组（50mm≤AFI＜80 mm）18例;羊水过少组（AFI＜50 mm）22例.观察各组AFI、围产儿感染、胎儿窘迫、新生儿窒息情况、新生儿呼吸窘迫综合症（NRDS）、新生儿呼吸 衰竭（RF）、新生儿缺血缺氧性脑病（HIE）、缺血缺氧性心肌损害等,并对各组的围产儿病例情况进行分析.结果 三组新生儿败血症12例,羊水量过少组6例（50.0%,6/12）,羊水量偏少组4例（33.3%,4/12）,羊水量正常组2例（16.7%,2/1 2）,三组分别比较,差异有显著性（P＜0.05）.羊水量过少组胎儿窘迫6例（50.0%）、新生儿窒息7例（53.8%）、缺血缺氧性心肌损伤12例（48.0%）,明显高于羊水量正常组（分别为8.3%、15.3%、12.0%）,差异均有显著性（P＜0.05）.三组的NRDS、呼吸衰竭、新生儿HIE发生率分别比较,差异无显著性（P＞0.05）,且胎膜早破时孕周越小,新生儿感染、新生儿死亡率越高.结论 PPROM剩余羊水量过少与胎儿窘迫、新生儿窒息、新生儿败血症、新生儿缺血缺氧性心肌损害的增加有关;PPROM剩余羊水量可作为围生儿病率有效预测指标.

Objective To determine the relationship between the residue amniotic fluid volume after preterm premature rupture of membranes（PPROM） and perinatal morbidity. Methods Eightytwo pregnant woman women with PPROM during 28-36 gestational weeks were studied, hospitalized in Shaoguan maternal Maternal and child Child health Health Hospital from Dec.2004 to Dec.2009, and The fFirst People＇s hHospital of aShaoguan cCity from Dec,2004 to Dec,2009. All patients are were willing to take part in these experiments. According to Amniotic amniotic fluid index（AFI） by ultrasound, patients were devided into three groups： （1）① Group of oligohydramnis ：AFI〈50 mm;（2） ② Group of borderline oligohydramnios： 50 mm ≤ AFI〈80 mm; ③（3） Group of normal amniotic fluid： 80mm ≤ AFI〈180mm.All the groups were similar with patient＇s＇ age. neonatal respiratory distress syndrome,neonatal hypoxic ischemic encephalopathy and neonatal respiratory failure （ P〉0.05 ）. Results Group of oligohydramnios fetal distress （50%）, neonatal asphyxia（50%）, early-onset neonatal sepsis（53.8） and hypoxic-ischemic myocardial injury（48.0%） than those in Group group of normal amniotic fluid（8.3%, 16.7%, 15.3%, 12.0%;P〈0.05）. Conclusions Oligohydramnios after pprom is associated fetal distress ,neonatal asphyxia,early-onset neonatal sepsis and hypoxic-ischemic myocardial injury.so, tThe amniotic fluid volume might be an important prognostic indicator to assess perinatal morbidity when PPROM happenedhappens.