某医院599例早产病例临床特征分析

Clinical features of premature birth:a report of 599 cases from a hospital

目的 了解重庆某大型综合医院近6年早产病例的临床特征。 方法 以医院病历资料为基础，收集、整理2007－2012年收治的早产住院分娩病历。应用SPSS 13.0软件录入并统计相关数据。以个体特征、早产特征和治疗情况为观察内容，分析、描述相关指标的特点。 结果 纳入分析的早产病例599例，其全部经过产前预防保健综合干预。6年间该院早产率依次为6.2%、5.4%、5.7%、4.6%、4.5%、3.9%，有下降趋势；极早、早期、中期及晚期早产的构成比分别为1.2%、10.0%、14.4%及74.5%；治疗性早产比率65.4%；≥3孕次的早产构成比（46.6%），远高于1、2孕次组（25.0%、28.4%）；65%的早产妇有流产史，其中手术流产史最高（51.9%）；＜18岁和＞40岁年龄组的早产率12.5%，明显高于其他年龄组平均值（3.8%）；早产妇孕期合并症前3位为糖尿病（15.0%）、贫血（9.7%）和乙肝（6.0%）；早产妇妊娠并发症前3位是胎膜早破（42.4%）、妊娠胆淤症（16.7%）、前置胎盘（9.7%）；早产儿体质量＜2.5 kg者约43%；脐带绕颈25.9%；晚期早产儿评分8～10分（正常）构成率为91.7%,远高于极早及早期早产儿；早产妇与非早产妇相比，其人均住院日和人均总费用明显增加。 结论 经过孕期保健干预的住院分娩人群早产率呈逐年下降趋势，治疗性早产率高，妊娠并发症亟待防控。

Objective To investigate the clinical features of premature birth from a large-scale hospital in Chongqing. Methods Based on the medical records, clinical data of women who gave birth prematurely in a certain hospital from 2007 to 2012 were collected, and analyzed for individual characteristics, premature birth and treatment. The software SPSS 13.0 was used to for statistical analysis on the data. Results There were 599 cases of premature birth brought into our analysis. Before delivery, all of these cases had received the prenatal and pregnancy health care. During the past 6 years, the rate of premature birth were 6.2%, 5.4%, 5.7%, 4.6%, 4.5% and 3.9% respectively, in a trend of decreasing. The proportion of premature birth at extremely early stage, early stage, mid-term, and late stage were 1.2%, 10.0%, 14.4% and 74.5% respectively. Therapeutic preterm birth accounted for 65.4%. The proportion of premature birth was apparently higher for women who had more than 3 times of pregnant history （46.6%） than those with pregnant history of once （25.0%） or twice （28.4%）. Among these women, 65% of them had a miscarriage history, and 51.9% were surgical abortion. The premature birth rate was 12.5% for women who were younger than 18 and older than 40, significantly higher than the other age groups （3.8%）. The proportions of top 3 complications during pregnancy were diabetes mellitus （15.0%）, anemia （9.7%） and hepatitis B （6.0%）. The top 3 pregnancy complications were premature rupture of membrane （42.4%）, intrahepatic cholestasis of pregnancy （16.7%） and placenta praevia （9.7%）. There were 43% neonates with weight lower than 2.5 kg, and 25.9% with umbilical cord around the neck. The percentage of the newborn infants with normal Apgar score was 91.7% in the women with premature birth of late stage, significantly higher than those of extremely early stage and early stage. The days of hospital stay and cost were greater in the premature birth than in non-premature birth women. Conclusion Prenatal and pregnancy health care makes the incidence of premature birth in a trend of decreasing. But therapeutic preterm birth rate is still high, and pregnant complications need to be well prevented and controlled.