围产儿死亡相关因素的配对病例对照研究

A matched case-control study on related factors of perinatal death

目的分析和探讨影响围产儿死亡的相关因素,旨在寻找有针对性的预防措施。方法回顾性分析北京军区总医院2009-2015年围产儿死亡评审资料,以74例围产儿死亡病例为病例组,按1∶1配对病例对照研究的原则选择对照,对可能影响围产儿死亡的25项常见的因素先行χ2检验和t检验,再应用条件Logistic回归对数据进行多因素回归分析。结果有8个变量进入了多因素条件Logistic回归方程,其中,保护因素有产前检查（OR：0.062,95%CI：0.005~0.765）、围产儿出生体重较高（OR：0.153,95%CI：0.052~0.618）、产妇为本市户籍（OR：0.123,95%CI：0.022~0.701）;危险因素有出生缺陷（OR：34.366,95%CI：3.166~373.033）、胎膜早破史（OR：21.384,95%CI：2.409~189.886）、脐带异常（OR：7.231,95%CI：1.412~37.093）、妊娠合并征（OR：5.981,95%CI：1.936~49.131）、不良孕产史（OR：3.866,95%CI：1.321~20.108）。结论宣传定期产前检查、孕期保健;避免胎膜早破的危险因素,尽量延长孕周;利用产前诊断技术,尽早发现胎儿畸形;孕晚期定期NST及B超检查;尽早发现并积极治疗各种妊娠合并症。

Objective To study the related factors of perinatal death and find targeted preventive measures,so as to provide scientific basis for effectively reducing perinatal mortality. Methods The data of 2009- 2015 perinatal death in the Beijing Military Area Comonand General Hospital PLA were summarized. 74 perinatal death cases were defined as the case group. The control group were recruited according to the principle of 1∶ 1 matched case-control study. The results of 25 related factors were analyzed with χ2or t test,and then were analyzed by multivariate conditional logistic regression analysis. Results There were 8 variables coming into the multifactor conditional logistic regression equation,among them,the protection factors were antenatal examinations（ OR： 0. 062,95%CI： 0. 005-0. 765）,perinatal high birth weight（ OR： 0. 153,95% CI： 0. 052-0. 618）,puerpera of this city＇s registered household（ OR： 0. 123,95% CI： 0. 022-0. 701）; risk factors of birth defects（ OR： 34. 366,95% CI： 3. 166-373. 033）,history of premature rupture of membranes（ OR： 21. 384,95% CI： 2. 409-189. 886）,and abnormal umbilical cord（ OR： 7. 231,95% CI： 1. 412-37. 093）,pregnancy complications（ OR： 5. 981,95% CI： 1. 936-49. 131）,abnormal pregnancy history（ OR： 3. 866,95% CI： 1. 321-20. 108）.Conclusions We put forward the corresponding effective measures to reduce perinatal mortality： strengthen antenatal examination and pregnancy health care; avoid risk factors of premature rupture of membranes,extend gestational age; prevent and intervene in preterm birth; find out fetal abnormalities by prenatal diagnosis technology; detect and treat pregnancy complications actively.