不同分娩方式产妇产褥期阴道微生态的变化及其影响因素

An Investigation of Vaginal Microbes in Different Ways of Delivery

目的探究正常分娩和剖宫产产妇在产褥期阴道微生态的变化及其影响因素。方法选取在2013年6月～2014年6月在本院妇产科足月分娩的产妇372例，将其分为阴道分娩组和剖宫产组，对2组产妇的产褥期阴道分泌物进行常规检查和细菌培养，并检测其性激素水平、阴道pH值以及细菌性阴道炎等，同时记录产妇血性恶露干净时间和产后复查时间等。结果与剖宫产组比较，阴道分娩组产妇的血性恶露干净时间、阴道pH值以及阴道pH值异常比例的差异均不具有统计学意义（P〉0．05），阴道分娩组产妇产褥期雌二醇、孕酮、睾酮、催乳激素水平明显高于剖宫产组，差异具有统计学意义（P〈0．05），黄体生成激素、卵泡生成激素水平的差异无统计学意义（P〉0．05）。与pH异常组比较，pH正常组产妇的血性恶露持续时间明显较短（P〈0．05）；pH值正常组的细菌性阴道炎弱阳性率和阴性率与pH值异常组相比，差异无统计学意义（P〉0．05）；pH值异常组的细菌性阴道炎阳性率明显高于pH值组正常产妇（P〈0．05）。结论产妇在产褥期阴道微生态失衡，pH值明显异常，乳酸杆菌数量明显下降，不同分娩方式细菌性阴道炎发生率没有明显差别。

Objective To reveal the change of vaginal microbe flora after vaginal delivery or cesarean delivery. Method Three hundreds and seventy two women who labored in hospital were selected for the study, among them 220 women were given cesarean delivery and 152 underwent vaginal delivery. The vaginal secretions were collected for detection of PH value, BV, and bacterial culture. Besides, The time of lochia disappearance in puerperium was recorded. Results There was no significant difference between the two groups in comparison of vaginal PH value and the time of lochia disappearance in puerperium （P〉0.05）. Compared with the subjects of cesarean delivery, the levels of E2, T, P and PRL in those whoc had vaginal delivery were statistically increased （P〈0.05）, while no significant difference was seen in LH and FSH （P〉0.05）. Compared with the women with abnormal vaginal PH value , the time of lochia disappearance in puerperium in the women with normal vaginal PH value was significantly decreased （P〈0.05）, and the positive rate of BV in women with normal vaginal PH value was also decreased （P〈0.05）. Conclusion the vaginal microbe flora seems to be unbalanced following vaginal or cesarean delivery and vaginal PH value is abnormal. Additionally, Lactobacillus spp may be significantly depressed , with a high incidence of BV in both ways of delivery.