433例早产的临床分析

The Clinical Analysis of 433 Cases of Preterm Birth

目的 了解孕妇宫颈状况和早产治疗对妊娠结局的影响。 方法 回顾性分析我院 5年 433例早产病例。 结果 早产发生率为 5 .2 % ,其中胎膜早破 (PPROM)、妊高征 (PIH)导致的早产分别占 41.6 %和 2 7.1%。硫酸镁与沙丁胺醇 (舒喘灵 )联合用药治疗先兆早产 ,延长孕周的时间(8d)长于单独应用硫酸镁 (2 d)。PPROM超过 2 4h者 6 8例 ,发生宫内感染 2 1例 ,破膜 2 4h以内 112例 ,仅有 1例宫内感染 (P<0 .0 0 1)。宫颈细菌培养阳性 2 4例中 ,发生临床宫内感染 13例 ,培养阴性2 2例中有 5例宫内感染 (P<0 .0 5 )。难产组新生儿颅内出血 (ICH)发生率 18.3% (34 / 186例 )高于顺产组 9.5 6 % (2 4/ 2 5 1例 ) (P<0 .0 5 )。 RDS的发生率在 <34周组 (5 .88% )明显高于≥ 34周组(0 .6 0 % ) (P<0 .0 1)。 结论 PPROM超过 2 4h,宫内感染的发生率增加 ;联合应用硫酸镁和沙丁胺酸治疗先兆早产可延长孕周。

Objective To evaluate the effect of cervical condition and management on preterm labor. Method 433 cases of preterm birth during the past 5 years in this hospital were reviewed. Results The incidence of preterm birth was 5.2%. Preterm birth induced by preterm (PROM) (PPROM) and PIH were 41.6% and 27.1%, respectively. The gestational weeks were prolonged longer in those treated with magnesium sulfate and salbutamol than that with magnesium sulfate alone. 21 cases of intraamniotic infection (IAI) were found in 68 patients with PPROM≥24 h, and only 1 case in 112 patients with PPROM <24h (P<0.001). 13 cases of clinical IAI were shown in 24 patients with positive cervical culture, and only 5 cases of clinical IAI in 22 patients with negative culture results (P<0.05). A higher incidence of intracranial hemorrhage (ICH) was seen in infants delivered by forceps and ceasarean section (34/186) than those in normal delivery (24/251) ( P < 0.05). The incidence of RDS in the group of <34 gestatienal weeks was significantly higher than that of ≥34 weeks group (5.88% vs 0.60%, P<0.01). Conclusions The rate of IAI was increased in patients with PPROM (≥24h). The use of magnesium sulfate and salbutamol in preferm labor may prolonged gestational weeks.