围产期发生胎膜早破的多因素分析

Analysis Multiple Factors to Perinatal Premature Rupture of Membranes Occurred

目的探讨围产期发生胎膜早破的多种相关影响因素的分析。方法依照病例定义选择2012年6月～2013年5月陕西省人民医院产科的正常孕产妇112例和胎膜早破的孕产妇108例，记录孕产妇的年龄、婚龄、初潮时间、初始性生活、周性交频次、安全套使用、不洁性交、吸烟、流产次数、生育胎次、第一胎产时间、孕周、胎位、羊水量、缺乏维生素C／微量元素铜／微量元素锌、孕后期咳嗽、孕后期性生活、便秘、妊娠期高血压及胎儿的体重和性别共21项因素；同时采集孕妇的阴道分泌物用定量PCR进行支原体、衣原体、念珠茵、B族链球茵的检测及阴道微生态的检测，综合分析以上27项相关因素对胎膜早破的影响及其导致的产后母婴感染。统计学方法：分类资料用卡方检验，计量资料用方差分析，支原体的感染采用对数转换后进行计量统计。结果对两组产妇研究的27项变量进行单因素分析得到：孕周、支原体感染在两组间的差异有统计学意义（t=2．435～6．093，P=0．005～0．027）；流产次数、吸烟、胎位、缺乏维生素C＼微量元素铜＼微量元素锌、孕后期咳嗽、阴道微生态失调、B族链球菌感染、衣原体感染在两组间的差异有统计学意义（x2=2．769～20．517，P=0．000～O．046）。同时胎膜早破组发生早产、新生儿肺炎、胎儿窘迫、产褥感染、羊膜炎感染比正常孕妇组高，两组间的差异有统计学差异（x2=4．96～36．5，P=0．000～0．035）。结论围产期发生胎膜早破是多因素影响的结果，而且可导致产后不良结局，建议临床应对胎膜早破进行早期的评估和治疗，避免因胎膜早破而引起的母婴感染。

Objective To discuss perinatal premature rupture of membranes occurred various related lactors analysm. Memoo~ According to the case definition selected 112 cases of normal pregnant women and 108 cases of maternal premature rup- ture of membranes in Shaanxi Province People＇s Hospital from June 2012 to May 2013. Recorded of maternal age,marriage age, menstruation, initiative life, weekly frequency of intercourse, condom use, feeulent sexual intercourse, smoking, abortion, birth times first, production time, gestational age, position and amount, and a lack of vitamin C, trace elements copper, trace elements zinc,late pregnancy cough,late pregnancy sex,constipation, gestational hypertension and fetal weight and sex fac- tors to the total 21. Used quantitative PCR to determine mycoplasma, chlamydia, eandida, and vaginal group B streptococcus in vaginal secretion from pregnant women, and detected vaginal microbiology. Comprehensively analyzed above 27 items of the influence of related factors of premature rupture of membranes and its cause of postpartum infection with statistical me^hods：classification data by chi-square test,measurement data using analysis of variance, mycoplasma infection after the logarithmic transformation was adopted to improve the measuremen^of statistics. Results Researched on two groups of ma- ternal 27 variables,there was statistically significant （t= 2. 435~ 6. 093,P= 0. 005~0. 027） for single factor analysis of ges- rational age,mycoplasma infection in the differences between the two groups. The number of abortions, smoking, and post- tion, a lack of vitamin C, trace elements copper, trace elements zinc ,late pregnancy eough, vaginal microecologieal imbalance, group B streptococcus infection, chlamydia infection in the differences between the two groups was statistically significant （X2 =2. 769-20. 517,P=0. 000-0. 046）. Premature rupture of membranes and preterm delivery,neonatal pneumonia, fetal distress,puerperal infection, amniotic membrane inflammation infection was higher than normal pregnant women group, the differences between two groups was statistically difference （x2= 4. 96 -36.5, P = O. 000 - 0. 035）. Conclusion Perinatal premature rupture of membranes occurred is the result of many factors, and can lead to adverse outcomes after delivery, pre- mature rupture of membranes suggest that clinical response to early assessment and treatment, avoid caused by premature rupture of membranes of mother-to-child infections.