头孢曲松、克拉霉素和甲硝唑联合疗法对未足月胎膜早破患者结局的临床分析

Clinical analysis of the effect of combination use of ceftriaxone,clarithromycin and metronidazole on the neonatal outcome of patients with PPROM

目的对比两种不同的抗菌治疗方案对于未足月胎膜早破(PPROM)患者抗菌治疗的有效性及其对新生儿结局的影响。方法回顾性分析212例PPROM患者的围生期结局,患者在妊娠期<34周分别给予2种抗菌方案治疗;通过羊水培养阳性和羊水中MMP-8浓度升高评估羊膜内感染/发炎。结果给予方案二治疗的患者中位抗菌至分娩的时间较方案一延长(29.9 d vs.8.8 d,P<0.01);方案二治疗组患者急性组织学绒毛羊膜炎和脐带炎的发生率(50.4%、14.2%)低于方案一治疗组(66.7%、42.4%),差异有统计学意义(P<0.01);方案二组新生儿的心室内出血、脐带炎和大脑性麻痹的发生率低于方案一组(P<0.05)。结论头孢曲松、克拉霉素和甲硝唑联合疗法对于PPROM患者可以延长潜伏期,降低急性组织学绒毛膜羊膜炎和脐带炎发生率,改善新生儿的临床结局,表明联合用药(头孢曲松、克拉霉素和甲硝唑)有助于改善PPROM围生期结局。

Objective To compare the efficacy of two anti-microbial regimens in the treatment of patients with preterm premature rupture of the membranes （ PPROM）, and observe their effects on neonatal outcomes. Methods The perinatal outcomes of patients with PPROM were analyzed retrospectively, and 212 patients with PPROM less than 34 weeks were given two anti-microbial regimens. Intra-amniotic infection/inflammation was assessed by positive amni- otic fluid culture and elevation of amniotic fluid MMP-8 concentration. Results Patients in regimen Ⅱ group had a longer median antibiotic-to-delivery interval than regimen I group （29.9 d vs. 8.8 d,P 〈0. 01 ） ,and lower rates of a- cute histologic chorioamnionitis and funisitis （50. 4% vs. 66. 7% , P 〈 0. 01 ; 14. 2% vs. 42.4% , P 〈 0. 01 ）. The rates of neonatal intra-ventricular hemorrhage （IVH） and cerebral palsy （CP） in regimen Ⅱ group were lower than those of regimen I group （ P 〈 0. 05 ）. Conclusion Combination use of ceftriaxone, clarithromycin and metronidazole can pro- long the latency period, reduce the rate of acute histologic chorioamnionitis/funisitis, and improve neonatal outcomes of patients with PPROM. It suggests that the combination use of anti-microbial agents （ceftriaxone, clarithromycin and metronidazole） can improve the perinatal outcome in PPROM.